Paravertebral Nerve Block With Liposomal Bupivacaine for Pain Control Following Video-Assisted Thoracoscopic Surgery and Thoracotomy

NeMoyer, Rachel; Pantin, Enrique J.; Aisner, Joseph; Jongco, R.; Mellender, Scott J.; Chiricolo, Antonio; Moore, Dirk F.; Langenfeld, John

doi:10.1016/j.jss.2019.07.093

Cited by 14 publications

(8 citation statements)

References 16 publications

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“…Anesthesia maintenance: 2–6 mg/(kg·h) propofol (Sichuan Guorui Pharmaceutical Co., Ltd., H20040079) and 0.10–0.20 μ g/(kg·min) remifentanil (Yichang Renfu Pharmaceutical Co., Ltd., H20143314) were given via intravenous infusion, and cis-Atracurium was intermittently injected to maintain the heart rate (HR) and mean arterial pressure (MAP) fluctuations that do not exceed 25% of the baseline value. The intravenous analgesia pump was connected when the patient left the resuscitation room 1 h after the operation [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

Effects of Different Doses of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block Anesthesia on Agitation and Hemodynamics in Patients Undergoing Thoracotomy during Recovery

Baoli¹,

Yang²,

Shi³

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the effect of different doses of dexmedetomidine combined with thoracic paravertebral nerve block anesthesia on agitation and hemodynamics in patients undergoing thoracotomy during recovery. Methods. One hundred patients who underwent thoracotomy in our hospital from August 2018 to April 2021 were enrolled and assigned (1 : 1 : 1 : 1) into 4 groups via the random number table method. The patients in the control group were treated with double-lumen tube general anesthesia + ropivacaine for thoracic paravertebral nerve block anesthesia; patients in experimental group A received double-lumen general anesthesia +0.5 μg·kg−1 dexmedetomidine + ropivacaine for thoracic paravertebral nerve block anesthesia; patients in experimental group B received thoracic paravertebral nerve block anesthesia with double-lumen general anesthesia +1.0 μg·kg−1 dexmedetomidine + ropivacaine; patients in experimental group C received thoracic paravertebral nerve block anesthesia with double-lumen general anesthesia +1.5 μg·kg−1 dexmedetomidine + ropivacaine. The postoperative recovery time and visual analog scale (VAS), level of hemodynamics (heart rate (HR), mean arterial pressure (MAP)), agitation during the recovery period, and complications were compared amongst the 4 groups of patients at different time points. Results. The postoperative VAS scores of patients in groups B2 and B3 were slightly lower than those of patients in groups A and B1, but a one-way analysis of variance revealed no statistical difference in the postoperative recovery time and VAS pain scores of the four groups ( P > 0.05 ), and the recovery time of patients in experimental group C was slightly higher than that of patients in group B2. At T0 and T1, there was no significant difference in the levels of HR and MAP among the four groups ( P > 0.05 ). The levels of HR and MAP of the patients in groups B2 and B3 were significantly different from the patients in the control group and experimental group A at T2 and T3 ( P < 0.05 ). The patients in experimental group B and experimental group C showed better outcomes than those in the control group and experimental group A in the assessment of agitation during the recovery period ( P < 0.05 ). There was no significant difference in the incidence of complications among the four groups ( P > 0.05 ). Conclusion. In line with the principle of preference for a small anesthesia dose, 1.0 μg·kg−1 dose of dexmedetomidine combined with ropivacaine produces a pronounced efficacy in patients undergoing thoracotomy. It effectively controls the occurrence of agitation during the recovery period and maintains the stability of the patient’s hemodynamics, with a high clinical safety profile.

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Section: Methodsmentioning

confidence: 99%

Effects of Different Doses of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block Anesthesia on Agitation and Hemodynamics in Patients Undergoing Thoracotomy during Recovery

Baoli¹,

Yang²,

Shi³

2022

Evidence-Based Complementary and Alternative Medicine

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“…Bupivacaine liposomes had a 72-h duration of action, which just rekindles the interest in the use of single-shot anesthetics and prolongs relief of thoracoscopic postoperative pain. Improving pain control during the perioperative phase will not only reduce LOS and patient satisfaction, but it will also allow for a reduction in opioid use ( 59 , 60 ). Meanwhile, it eliminates the need for ongoing nerve blocks, makes catheterization easier, and increases the risk of infection ( 50 ).…”

Section: Discussionmentioning

confidence: 99%

Regional Analgesia in Video-Assisted Thoracic Surgery: A Bayesian Network Meta-Analysis

et al. 2022

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BackgroundA variety of regional analgesia methods are used during video-assisted thoracic surgery (VATS). Our network meta-analysis (NMA) sought to evaluate the advantages of various methods of localized postoperative pain management in VATS patients.MethodsPubMed, the Cochrane Library, and EMBASE were searched from their date of inception to May 2021 for randomized controlled trials (RCTs) comparing two or more types of locoregional analgesia in adults using any standardized clinical criteria. This was done using Bayesian NMA.ResultsA total of 3,563 studies were initially identified, and 16 RCTs with a total of 1,144 participants were ultimately included. These studies, which spanned the years 2014 to 2021 and included data from eight different countries, presented new information. There were a variety of regional analgesia techniques used, and in terms of analgesic effect, thoracic epidural anesthesia (TEA) [SMD (standard mean difference) = 1.12, CrI (Credible interval): (−0.08 to −2.33)], thoracic paravertebral block (TPVB) (SMD = 0.67, CrI: (−0.25 to 1.60) and erector spinae plane block (ESPB) (SMD = 0.34, CrI: (−0.5 to 1.17) were better than other regional analgesia methods.ConclusionOverall, these findings show that TEA, TPVB and ESPB may be effective forms of regional analgesia in VATS. This research could be a valuable resource for future efforts regarding the use of thoracic regional analgesia and enhanced recovery after surgery.Systematic Review RegistrationIdentifier [PROSPERO CRD42021253218].

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“…Generally, patients undergoing thoracotomy have a strong traumatic stress response, which increases blood levels of metabolic hormones, such as glucagon and cortisol, thus increasing the risk for glucose metabolism disorders during surgery. This is a significant issue when profound anesthesia is required, which can lead to difficulty in maintaining hemodynamic stability, including blood flow to the heart and brain[ 18 ]. Traditional thoracoscopic surgery uses a combination of general anesthesia and local infiltration anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients

Zhen¹,

Jin²,

Chen³

et al. 2022

WJCC

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BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response, loss of hemodynamic stability, and decreased immune function. Herein, we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia, in combination with general anesthesia, for thoracic surgery for lung cancer. The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block. AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice. METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020. Patients were randomly allocated to the peripheral + general anesthesia (observation) group ( n = 74) or to the general anesthesia (control) group ( n = 66). Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia, with those in the control group receiving an epidural block combined with general anesthesia. Measured outcomes included the operative and anesthesia times, as well as the mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO 2 ) measured before surgery, 15 min after anesthesia (T1), after intubation, 5 min after skin incision, and before extubation (T4). RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group (1.48 ± 0.43 mg, 760.50 ± 92.28 mg, and 72.50 ± 16.62 mg, respectively) than control group ( P < 0.05). At the four time points of measurement (T1 through T4), MAP and HR values were higher in the observation than control group (MAP, 90.20 ± 9.15 mmHg, 85.50 ± 7.22 mmHg, 88.59 ± 8.15 mmHg, and 90.02 ± 10.02 mmHg, respectively; and HR, 72.39 ± 8.22 beats/min, 69.03 ± 9.03 beats/min, 70.12 ± 8.11 beats/min, and 71.24 ± 9.01 beats/min, respectively; P < 0.05). There was no difference in SpO 2 between the two groups ( P > 0.05). Postoperative levels of epinephrine, norepinephrine, and dopamine used were significantly lower in the observation than control group (210.20 ± 40.41 pg/mL, 230.30 ± 65.58 pg/mL, and 54.49 ± 13.32 pg/mL, respectively; P < 0.05). Similarly, the postoperative tumor necrosis factor-α and interleukin-6 levels were lower in the observation (2.43 ± 0.44 pg/mL and 170.03 ± 35.54 pg/mL, respectively) than control group ( P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( ...

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Paravertebral Nerve Block With Liposomal Bupivacaine for Pain Control Following Video-Assisted Thoracoscopic Surgery and Thoracotomy

Cited by 14 publications

References 16 publications

Effects of Different Doses of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block Anesthesia on Agitation and Hemodynamics in Patients Undergoing Thoracotomy during Recovery

Effects of Different Doses of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block Anesthesia on Agitation and Hemodynamics in Patients Undergoing Thoracotomy during Recovery

Regional Analgesia in Video-Assisted Thoracic Surgery: A Bayesian Network Meta-Analysis

Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients

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