Comparison of analgesic efficacy of the conventional approach and mid-transverse process to pleura approach of the paravertebral block in video-assisted thoracoscopy surgeries: A randomised controlled trial

Abstract

Background and Aims: The paravertebral block (PVB) is an effective alternative to thoracic epidural analgesia for post-operative analgesia in thoracic surgeries. Despite the use of ultrasound in PVB, the search for a safer approach continues. This study was conducted to compare the analgesic efficacy of conventional and mid-transverse process to the pleura (MTP) approach of the PVB. Methods: Forty patients aged between 18-60 years, posted for video-assisted thoracoscopic surgery, were enroled for this study. Patients were randomised into two groups using a random number table, and group allocation was done by the sealed opaque envelope method. One group received PVB by conventional approach (group CP). In contrast, patients in the other group (group MP) received PVB by the mid-transverse process to pleura (MTP) approach before induction of general anaesthesia under ultrasound guidance. The study's primary aim was to compare analgesic consumption in the first 24 hours. Secondary aims were comparing the Visual Analogue Scale (VAS) score, block performance time, dermatomal spread, haemodynamic parameters such as heart rate (HR), oxygen saturation (SpO 2 ), and non-invasive blood pressure (NIBP), patient satisfaction scores, and complications observed. Data were analysed using Statistical Package for the Social Sciences version 23. Results: Demographic parameters, block performance time, and dermatomal distribution were comparable in both groups. We did not find any statistical difference in the analgesic consumption in the first 24 hours ( P = 0.38), VAS at rest or on movement, complication rates, and patient satisfaction scores between the groups. Conclusion: The MTP approach of the PVB is as effective as the conventional thoracic paravertebral approach for post-operative analgesia in video-assisted thoracoscopic surgeries.

Insignificant influence of the intertransverse process block for major breast cancer surgery: a randomized, blinded, placebo-controlled, clinical trial

“…Allegedly, the ITP block is effective in both breast cancer surgery and in video-assisted thoracoscopic surgeries8 9 with multiple-injection presumably advantageous in regard to dermatomal coverage12 in comparison to single injection 10. However, despite evidence that the ITP block is an opioid-sparing modality, the actual saved cumulated opioid quantity in various studies seems clinically inconsequential 11…”

“…Concurrently, increasing international considerations regarding non-epidural pain amelioration of the thoracic wall are leading to alternative techniques. Although an abundance of ITP blocks has emerged, compelling evidence of clinical efficacy of ITP blocks remains sparse 8 9. Furthermore, ITP blocks have not been thoroughly investigated in patients undergoing breast cancer surgery in randomized placebo-controlled trials 10–12…”

Quest for the Elusive Mechanism of Action for the Thoracic Paraspinal Nerve Block Techniques. Are We Ignoring the Anatomy of the “Retro Superior Costotransverse Ligament Space?”

“…Currently, there is paucity of clinical data on the ITPBs, and future research should validate our clinical assumptions. Overall, we can surmise that it is desirable to perform the TPSB more centrally into the retro-SCTL space, with one of the ITPBs, 1,4,28,48 to encourage LA spread to the TPVS and neuraxis (the site of neural blockade), when anesthesia and or analgesia of the anterolateral hemithorax is intended. In contrast, when a TPSB is used to provide analgesia for back or thoracic spine surgery (eg, scoliosis), 53 then a peripheral injection into the retro-SCTL space, with an ESPB or RLB, may be preferable.…”

“…1 The SCTL does not appear to be a watertight barrier since there are fenestrations or gaps within its architecture 25,40 that supposedly allows physical spread of LA to the TPVS 1,3 after an injection into the "ITTC." 3 This is also one of the proposed mechanisms by which the TPSBs produce anesthesia [45][46][47] and or analgesia [45][46][47][48] for surgery on the ipsilateral hemithorax.…”

Advancing, strengthening and reshaping obstetric critical care with Point-of-Care Ultrasound (POCUS)

“…Apart from the usual and new blocks for limb surgeries being performed under vision,[ 4 5 6 7 8 9 ] with the diminishing size of the machine and better resolution, a whole armamentarium of fascial plane blocks and surrogate central neuraxial blocks such as paravertebral[ 10 11 12 ] and erector spinae plane blocks[ 13 14 15 16 17 ] are now available to the anaesthesiologists. Spinal,[ 18 19 ] epidural[ 20 21 22 ] and even caudal blocks[ 23 ] can now be performed under vision, especially in paediatrics.…”