Comparison of Paravertebral Block by Anatomic Landmark Technique to Ultrasound-Guided Paravertebral Block for Breast Surgery Anesthesia

Patnaik, Rupali; Chhabra, Anjolie; Subramaniam, Rajeshwari; Arora, Manali; Goswami, Devalina; Srivastava, Anurag; Seenu, Vuthaluru; Dhar, Anita

doi:10.1097/aap.0000000000000746

Cited by 35 publications

(17 citation statements)

References 25 publications

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“…Inadvertent vascular puncture in particular has been reported in 13 publications. [98][99][100][101][102][103][104][105][106][107][108][109][110] These were reported across a range of adult and pediatric populations, under anatomic and ultrasound guidance, during single shot and catheter blocks, and with rates in these reports of between one-in-527 102 and one-in-eight. 105 None of these cases resulted in serious bleeding outcomes, despite the presence of therapeutic anticoagulation in two reports.…”

Section: Paravertebral Blockmentioning

confidence: 99%

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

Tsui

Kirkham

Kwofie

et al. 2019

Can J Anesth/J Can Anesth

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The risk of bleeding complications during regional anesthesia procedures is a significant patient safety consideration. Nevertheless, existing literature provides limited guidance on the stratification of bleeding risk for peripheral nerve and newly described interfascial plane blocks. Our objective was to produce an evidencebased consensus advisory that classifies bleeding risks in This article is accompanied by an editorial.

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Section: Paravertebral Blockmentioning

confidence: 99%

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

Tsui

Kirkham

Kwofie

et al. 2019

Can J Anesth/J Can Anesth

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“…12 An RCT comparing the anatomical landmark PVB technique to an ultrasound-guided technique for breast surgery showed that more patients had successful blocks with ultrasound. 13 Pain control, both at rest and movement, was superior and catheter top-ups were less frequent in the ultrasound group.…”

Section: Breast Surgerymentioning

confidence: 88%

Paravertebral blocks and novel alternatives

2020

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By reading this article, you should be able to: Describe the indications for paravertebral blocks. Discuss the different techniques used to perform a paravertebral block. Review the safety, complications and failure rates of landmark and ultrasound-guided techniques. Compare paravertebral blocks with the newer paraspinal blocks.The paravertebral block (PVB) was first described by Sellheim in 1905 and has been used widely since 1978 to treat both acute and chronic pain. 1 The PVB may be placed uni-or bilaterally, and either single-shot or continuous catheter techniques are possible. The advent of ultrasound has increased interest in PVB but also led to alternative paraspinal techniques including the erector spinae plane (ESP), retrolaminar, midpoint transverse process to pleura (MTP) and intercostal paraspinal blocks, all of which are purported to achieve blockade of thoracic nerve roots without entering the paravertebral space. 2,3 This article reviews the evidence base, and the different techniques for PVB. The newer paraspinal blocks are also discussed briefly.

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“…In a study by Patnaik and colleagues 16 comparing PVB by the anatomic landmark technique to the US-guided technique for breast surgery anesthesia, found that significantly more patients in the US group (34/36, 94.44%) had a successful block compared to the anatomic landmark group (26/36, 72.22%), and significantly more segments were blocked in the US group. The ribs, spinous and transverse processes of the vertebra, costotransverse joints, and pleura were utilized as sonographic landmarks.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound versus thoracoscopic-guided paravertebral block during thoracotomy

Hegazy

Awad

Abdellatif

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Paravertebral block can be performed with the aid of surgical landmarks, ultrasound, or a thoracoscope. This study was designed to compare ultrasound-guided paravertebral block with the thoracoscopic technique. Methods This prospective randomized comparative study included 40 adults scheduled for elective thoracic surgery. Study participants were randomized to an ultrasound group or a thoracoscope group. A catheter for paravertebral block was inserted prior to thoracotomy with real-time ultrasound visualization in the ultrasound group, and under thoracoscopic guidance in the thoracoscope group. Total analgesic consumption, visual analogue pain score, technical difficulties, and complications were compared between the 2 groups. Results Total analgesic consumption in the first 24 hours was less in the ultrasound group than in the thoracoscope group (rescue intravenous fentanyl 121.25 ± 64.01 µg in the ultrasound group vs. 178.75 ± 91.36 µg in the thoracoscope group; p = 0.027). Total paravertebral bupivacaine consumption was 376.00 ± 33.779 mg in the ultrasound group and 471.50 ± 64.341 mg in the thoracoscope group ( p < 0.001). Technical difficulties and complications in terms of time consumed during the maneuver, more than one needle pass, and pleural puncture were significantly lower in the ultrasound group than in the thoracoscope group. Conclusion Ultrasound-guided paravertebral catheter insertion is more effective, technically easier, and safer than the thoracoscope-assisted technique.

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Comparison of Paravertebral Block by Anatomic Landmark Technique to Ultrasound-Guided Paravertebral Block for Breast Surgery Anesthesia

Abstract: The trial was registered retrospectively at the Clinical Trial Registry of India, CTRI/2015/05/005774.

Cited by 35 publications

References 25 publications

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

Paravertebral blocks and novel alternatives

Ultrasound versus thoracoscopic-guided paravertebral block during thoracotomy

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