Effectiveness of Thoracic Wall Blocks in Video-Assisted Thoracoscopic Surgery, a Network Meta-Analysis

Scorsese, Giacomo; Jin, Zhaosheng; Greenspan, Seth H; Seiter, Christopher; Jiang, Yujie; Huang, Michael B; Lin, Jun

doi:10.2147/jpr.s396530

Cited by 6 publications

(3 citation statements)

References 63 publications

(54 reference statements)

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“…A meta-analysis conducted by Fenta et al showed superior results in terms of pain control during movement in the first 12 postoperative hours and less opioid consumption in PVB patients when compared to ESPB [32]. Even though ESPB also seems to show inferior results compared to epidural anesthesia, it still provides better pain control than intravenous opioids or SSINB alone [33][34][35] Although recent meta-analyses show the benefits of regional thoracic wall blocks, data on ICC with the continuous application of ropivacaine are still lacking and need further investigation [36,37].…”

Section: Discussionmentioning

confidence: 99%

Intercostal Catheters Reduce Long-Term Pain and Postoperative Opioid Consumption after VATS

Neuschmid,

Ponholzer,

et al. 2024

JCM

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Background/Objectives: Pain after video-assisted thoracoscopic surgery (VATS) leads to impaired postoperative recovery, possible side effects of opioid usage, and higher rates of chronic post-surgery pain (CPSP). Nevertheless, guidelines on perioperative pain management for VATS patients are lacking. The aim of this study was to analyze the effectiveness of intercostal catheters in combination with a single shot intraoperative intercostal nerve block (SSINB) in comparison to SSINB alone with respect to opioid consumption and CPSP. Methods: Patients receiving an anatomic VATS resection between 2019 and 2022 for primary lung cancer were retrospectively analyzed. A total of 75 consecutive patients receiving an ICC and SSINB and 75 consecutive patients receiving only SSINB were included in our database. After enforcing the exclusion criteria (insufficient documentation, external follow-ups, or patients receiving opioids on a fixed schedule; n = 9) 141 patients remained for further analysis. Results: The ICC and No ICC cohort were comparable in age, gender distribution, tumor location and hospital stay. Patients in the ICC cohort showed significantly less opioid usage regarding the extent (4.48 ± 6.69 SD vs. 7.23 ± 7.55 SD mg, p = 0.023), duration (0.76 ± 0.97 SD vs. 1.26 ± 1.33 SD days, p = 0.012) and frequency (0.90 ± 1.34 SD vs. 1.45 ± 1.51 SD times, p = 0.023) in comparison to the No ICC group. During the first nine months of oncological follow-up assessments, no statistical difference was found in the rate of patients experiencing postoperative pain, although a trend towards less pain in the ICC cohort was found. One year after surgery, the ICC cohort expressed significantly less often pain (1.5 vs. 10.8%, p = 0.035). Conclusions: Placement of an ICC provides VATS patients with improved postoperative pain relief resulting in a reduced frequency of required opioid administration, less days with opioids, and a reduced total amount of opioids consumed. Furthermore, ICC patients have significantly lower rates of CPSP one year after surgery.

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Section: Discussionmentioning

confidence: 99%

Intercostal Catheters Reduce Long-Term Pain and Postoperative Opioid Consumption after VATS

Neuschmid,

Ponholzer,

et al. 2024

JCM

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“…PVBs or other peripheral nerve blocks such as erector spinae plane (ESP) blocks [ 5 ] are increasingly used to manage rib fracture pain, as they have been shown to have comparable pain relief to epidurals with a better safety profile [ 6 ]. Serratus anterior plane (SAB) blocks can also be used for the management of rib fracture pain for patients in whom the placement of PVB, ESP, and epidural placement are contraindicated.…”

Section: Discussionmentioning

confidence: 99%

Acute Pain Management in a Multi-site Trauma Patient

Ayad,

Lee,

Diz Ferre

et al. 2024

Cureus

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Pain management is often difficult in the setting of multi-site trauma such as that caused by motor vehicle accidents (MVA), which is especially compounded in the setting of polysubstance abuse. This often results in patients with poor pain tolerance requiring escalating doses of opioid therapy, which creates a vicious cycle. The use of peripheral nerve blocks (PNB) has been shown to decrease overall opioid consumption and can be used effectively to manage postoperative pain in this patient population. Our case report aims to highlight the importance of PNBs as part of a multimodal approach to pain management in patients with polytrauma in the setting of polysubstance abuse.

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“…As technology advanced and expert consensus on FPBs developed, higher levels of clinical evidence emerged. This evolution includes well-designed randomized controlled trials 7 , 8 , meta-analysis 9 , network meta-analysis 31 , 32 , anatomical studies 4 , 5 , PROSPECT guidelines 21 , and AI studies 13 .…”

Section: Future Development Trend Of Fpbsmentioning

confidence: 99%

A progress of research on the application of fascial plane blocks in surgeries and their future direction: a review article

Bhushan,

Liu,

Jiang

et al. 2024

International Journal of Surgery

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Fascial plane blocks (FPBs) are gaining popularity in clinical settings owing to their improved analgesia when combined with either traditional regional anesthesia or general anesthesia during the perioperative phase. The scope of study on FPBs has substantially increased over the past 20 years, yet the exact mechanism, issues linked to the approaches, and direction of future research on FPBs are still up for debate. Given that it can be performed at all levels of the spine and provides analgesia to most areas of the body, the erector spinae plane block, one of the FPBs, has been extensively studied for chronic rational pain, visceral pain, abdominal surgical analgesia, imaging, and anatomical mechanisms. This has led to the contention that the erector spinae plane block is the ultimate Plan A block. Yet even though the future of FPBs is promising, the unstable effect, the probability of local anesthetic poisoning, and the lack of consensus on the definition and assessment of the FPB’s success are still the major concerns. In order to precisely administer FPBs to patients who require analgesia in this condition, an algorithm that uses artificial intelligence is required. This algorithm will assist healthcare professionals in practicing precision medicine.

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Effectiveness of Thoracic Wall Blocks in Video-Assisted Thoracoscopic Surgery, a Network Meta-Analysis

Cited by 6 publications

References 63 publications

Intercostal Catheters Reduce Long-Term Pain and Postoperative Opioid Consumption after VATS

Intercostal Catheters Reduce Long-Term Pain and Postoperative Opioid Consumption after VATS

Acute Pain Management in a Multi-site Trauma Patient

A progress of research on the application of fascial plane blocks in surgeries and their future direction: a review article

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