Distribution of injectate administered through a catheter inserted by three different approaches to ultrasound-guided thoracic paravertebral block: a prospective observational study

Termpornlert, Sivaporn; Sakura, Shinichi; Aoyama, Yuya; Wittayapairoj, Aumjit; Kishimoto, Kenji; Saito, Yoji

doi:10.1136/rapm-2020-101545

Cited by 17 publications

(8 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Termpornlert et al indicated that the effects of continuous TPVB are unpredictable. 23 One possible way to circumvent the unpredictable spread of local anesthetic through a catheter is to use an intermittent bolus injection of a relatively large volume instead of continuous infusion. No significant differences in the postoperative pain score were observed between TPVB and TEA at 24 and 48 hours.…”

Section: Discussionmentioning

confidence: 99%

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

Liang¹,

An²,

Chen³

et al. 2021

JPR

View full text Add to dashboard Cite

Background To date, there is no definitive evidence for the analgesic effects and side effects of thoracic epidural anesthesia (TEA) versus thoracic paravertebral block (TPVB) after thoracoscopic surgery. In this study, we conducted a meta-analysis of published randomized clinical trials (RCTs) to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery. Methods We systematically searched RCTs published by October 26, 2020, in PubMed, EMBASE, and Cochrane library and conducted a meta-analysis to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery. The primary measure was postoperative pain score, and the secondary measures were postoperative 24-hour usage of opioids, hypotension, postoperative nausea, and vomiting. Results A total of 458 patients from five RCTs were included in this study. After thoracoscopic surgery, the numerical rating scale (NRS) score for resting pain was higher in the TPVB group than in the TEA group at 1–2 hours and 4–6 hours after surgery (MD = 0.44, 95% CI = 0.24 to 0.64, P < 0.0001, I2 = 0%; MD = 0.47, 95% CI = 0.23 to 0.70, P < 0.0001, I2 = 0%). The postoperative 24-hour usage of morphine was higher in the TPVB group than in the TEA group (SMD = 0.67; 95% CI = 0.03 to 1.31; P = 0.04; I2 = 84%). The incidence of hypotension was significantly lower in the TPVB group than in the TEA group (OR = 4.52; 95% CI = 2.03 to 10.10; P = 0.0002; I 2 = 0%). No significant between-group difference was observed in postoperative nausea and vomiting (PONV). Conclusion Compared with TPVB, TEA provides statistically significant but clinically unimportant short-term benefits following thoracoscopic surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

Liang¹,

An²,

Chen³

et al. 2021

JPR

View full text Add to dashboard Cite

show abstract

“…The decision not to use sensory loss as a definition of the successful block was based on the fact that the extent of skin anaesthesia achieved by ESPB still needs to be established in the literature. [7][8][9] Second, we used a fixed level for catheter placement, which was not individualised according to the location of incisions and chest tube since the limited dermatomal distribution of LA is common with continuous PVB, 35,36 that might have a minor impact on the early outcomes but a significant influence on the later postoperative assessments. Third, the possibility of using sevoflurane as a hypnotic agent and the heterogeneity of surgeries included in this study was another concern; however, randomisation mitigated this.…”

Section: Discussionmentioning

confidence: 99%

Analgesic efficacy of erector spinae plane block versus paravertebral block in lung surgeries—A non‐inferiority randomised controlled trial

Andrade Filho,

Pereira,

Sousa

et al. 2023

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

BackgroundPain management plays an essential role in postoperative recovery after lung surgeries. The Erector Spinae Plane Block (ESPB) is a widely used regional anaesthesia technique; however, few clinical trials have compared this block to active control in thoracic surgeries. This study evaluated the non‐inferiority of the analgesia provided by ESPB when compared to paravertebral block (PVB) in lung surgeries.MethodsRandomised, active‐controlled, blinded for patients and assessors, non‐inferiority trial. Patients who underwent unilateral lung surgeries were divided into two groups according to the regional anaesthesia technique—continuous ESPB or PVB at the T5 level. The primary outcome was to assess pain using a numerical rating scale (NRS) with a test of the interaction of three measures over 24 h postoperatively. An NRS score ≥ 7 was considered analgesia failure, and the prespecified non‐inferiority margin was 10%.ResultsIn the interim analysis that terminated this study, 120 participants were enrolled. ESPB patients reported higher mean NRS general values over 24 h, 4.6 ± 3.2 in the ESPB group versus 3.9 ± 2.9 in the PVB group, with a difference of −0.67 (−15.2%) and 95%CI: −1.29 to −0.05 (p = .02), demonstrating not non‐inferiority. In addition, the ESPB group presented higher NRS failure of analgesia over 24 h (p < .01) and required more postoperative opioids (p = .01 over 24 h). There was no difference in patient satisfaction between groups.ConclusionThis trial demonstrated that a continuous erector spinae plane block was not non‐inferior to a continuous paravertebral block for analgesia after lung surgery but resulted in higher levels of postoperative pain and opioid consumption.

show abstract

“…Previous studies have shown that even experienced physicians often place catheter tips distant from the target position, leading to inadequate analgesia. [12][13][14] Local anesthetics have been supplemented with various adjuvants, including clonidine, neostigmine, epinephrine, buprenorphine, dexmedetomidine, and dexamethasone, as a single injection to enhance postoperative analgesia of peripheral nerve blocks. Dexamethasone is a potent anti-inflammatory drug with a long half-life.…”

Section: Introductionmentioning

confidence: 99%

Analgesic Efficacy of Intravenous Dexamethasone as an Adjunct to Ultrasound-Guided Paravertebral Block with Bupivacaine in Video-Assisted Thoracoscopic Surgery

Termpornlert¹,

Vijitpavan²,

Ngodngamthaweesuk³

et al. 2022

JPR

Self Cite

View full text Add to dashboard Cite

Purpose Thoracic paravertebral block (TPVB) is a recommended regional analgesia during video-assisted thoracoscopic surgery (VATS). However, single-injection TPVB does not last long enough to provide sufficient acute postoperative pain relief. Continuous TPVB through a catheter is technically challenging and often unreliable. Intravenous dexamethasone extends the analgesic duration with some peripheral nerve blocks. However, data on the effect of intravenous dexamethasone on pain relief with TPVB are limited. This study aimed to assess the analgesic efficacy of intravenous dexamethasone in patients who received TPVB for VATS. Patients and Methods In this multicenter prospective randomized controlled trial, we recruited patients aged between 18 and 80 years with the American Society of Anesthesiologists of physical status class 1–3 and underwent elective VATS. Patients under general anesthesia randomly received 8 mg of intravenous dexamethasone (group D) or normal saline (group C). Ultrasound-guided TPVB (USG-TPVB) was performed at the T4–T5 and T6-T7 spaces. Multimodal analgesia was achieved via paracetamol, tramadol and intravenous morphine for both study groups. The primary outcome was time for the first analgesic requirement. Postoperative pain in terms of numeric rating score (NRS), total morphine consumption and postoperative nausea and vomiting (PONV) were assessed. Results After excluding one patient, 59 patients were analyzed. There were no intergroup differences in baseline characteristics. The time to first analgesic requirement was longer in group D (305 [240, 510] minutes) than in group C (270 [180, 300] minutes) ( P value = 0.02). The NRS at rest and on movement was lower in group D than in group C at 12 hours but did not differ at other time points. Postoperative morphine consumption was significantly lower in group D than in group C at 6,12,24 and 48 hours. Incidences of PONV were comparable between the groups. Conclusion Intravenous dexamethasone, used as an adjunct to a single-injection USG-TPVB prolonged analgesic duration, had an opioid-sparing effect and provided better postoperative pain relief after VATS.

show abstract

Distribution of injectate administered through a catheter inserted by three different approaches to ultrasound-guided thoracic paravertebral block: a prospective observational study

Cited by 17 publications

References 26 publications

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

Analgesic efficacy of erector spinae plane block versus paravertebral block in lung surgeries—A non‐inferiority randomised controlled trial

Analgesic Efficacy of Intravenous Dexamethasone as an Adjunct to Ultrasound-Guided Paravertebral Block with Bupivacaine in Video-Assisted Thoracoscopic Surgery

Contact Info

Product

Resources

About