Perioperative analgesia during thymectomy via median sternotomy

Song, Wenqin; Wang, Wei; Li, Zhan

doi:10.1007/s00101-019-00700-w

Cited by 14 publications

(6 citation statements)

References 14 publications

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“…19 Parasternal intercostal block (PSI block), wherein the anesthesia is injected into the plane deep underneath pectoralis major muscle, was developed for median sternotomy and anesthetizes the anterior cutaneous branches of TICN. 20 Therefore, PSI can supplement PECS I and SIPB in breast cancer survivors. 21 Considering the scope of the surgical incision in MRM, we hypothesized that the addition of PSI block to the typical PECS I and SIPB will improve peri-operative pain relief in MRM patients.…”

Section: Introductionmentioning

confidence: 99%

<p>Rasternal Intercostal Block Complementation Contributes to Postoperative Pain Relief in Modified Radical Mastectomy Employing Pectoral Nerve Block I and Serratus-Intercostal Block: A Randomized Trial</p>

Song¹,

Wang²,

Yang³

et al. 2020

JPR

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Purpose: Pectoral nerve block I (PECS I) and serratus-intercostal plane block (SIPB) can anesthetize the majority mammary region, while parasternal intercostal block (PSI) targets the internal area during breast resection surgery. The aim of this study was to determine whether including PSI with PECS I and SIPB is more effective compared to PECS I and SIPB alone. Patients and Methods: Sixty-two adult females undergoing unilateral modified radical mastectomy (MRM) were randomly assigned to receive either PECS I and SIPB (PS group, n=31) or a combination of PECS I, SIPB, and PSI (PSP group, n=31). The outcomes were measured with a numerical rating scale (NRS) score, and in terms of opioid consumption and anesthesia-related complications within 48 h after surgery. Results: Although there were no differences in the NRS scores between the two groups during the inactive periods, the combination of three nerve blocks significantly reduced the NRS scores during movement. In addition, morphine equivalent consumption was lower in the PSP group compared to the PS group. Postoperative adverse events were similar in both groups in terms of regional anesthesia-related complications. Conclusion: The combination of PECS I block, SIPB, and PSI block provides superior pain relief and postoperative recovery for patients undergoing MRM.

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Section: Introductionmentioning

confidence: 99%

<p>Rasternal Intercostal Block Complementation Contributes to Postoperative Pain Relief in Modified Radical Mastectomy Employing Pectoral Nerve Block I and Serratus-Intercostal Block: A Randomized Trial</p>

Song¹,

Wang²,

Yang³

et al. 2020

JPR

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“…18,19 Because the transverse thoracic muscle lies on the inner surface of the front wall of the thoracic cage, covering the outer edge of the sternum and costal cartilages, the injected local anesthetic can spread across the multiple intercostal spaces. As a result of this spread of the local anesthetic along the TTP, it does not require as many punctures as does the PSB and it is not necessary for the puncture needle to advance close to the lower edge of the rib (where the intercostal nerve, artery, and vein are located), 20 which would entail a risk of nerve injury or bleeding. The TTP block is reported to be able to target the region encompassing the multiple anterior branches of the intercostal nerves (T2-T6) 21,22 ; however, analgesia efficacy has been found to be unstable in the region of the 6th intercostal nerve in adults.…”

Section: Regional Anesthesia Strategy For Sternotomy In Cardiac Surgerymentioning

confidence: 99%

Preoperative Implementation of Transverse Thoracic Muscle Plane Block and Rectus Sheath Block Combination for Pediatric Cardiac Surgery

Yamamoto

Seino

Matsuda

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…Parasternal intercostal nerve block was carried out as previously described (11,15,17,18). The in-plane needle approach was applied under guidance of a high frequency linear-array ultrasound transducer.…”

Section: Nerve Block Proceduresmentioning

confidence: 99%

“…Recently, we described a case administered USG bilateral parasternal block for perioperative analgesia during thymectomy via median sternotomy (15). Based on this case report, we hypothesized that USG parasternal intercostal nerve block in mediastinal mass resection with median sternotomy is a useful tool in controlling postoperative pain and could reduce opioid requirements in patients receiving sufentanil patient-controlled intravenous analgesia (PCIA) during the rst 24 hours following surgery.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided Parasternal Intercostal Nerve Block for Postoperative Analgesia in Mediastinal Mass Resection by Median Sternotomy: a Randomized, Double-blind, Placebo-controlled Trial

Chen

Song

Wang

et al. 2020

Preprint

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Background: Ultrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear. This study aimed to evaluate the effectiveness of ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in patients undergoing median sternotomy for mediastinal mass resection.Methods: This randomized, double-blind, placebo-controlled trial performed in Renmin Hospital, Wuhan University, enrolled 41 participants aged 18-65 years. The patients scheduled for mediastinal mass resection by median sternotomy were randomly assigned were randomized into 2 groups, and preoperatively administered 2 injections of ropivacaine (PSI) and saline (control) groups, respectively, in the 3rd and 5th parasternal intercostal spaces with ultrasound-guided (USG) bilateral parasternal intercostal nerve block. Sufentanil via patient-controlled intravenous analgesia (PCIA) was administered to all participants postoperatively. Pain score, total sufentanil consumption, and postoperative adverse events were recorded within the first 24 hours.Results: There were 20 and 21 patients in the PSI and control group, respectively. The PSI group required 20% less PCIA-sufentanil compared with the control group (54.05 ± 11.14 μg vs. 67.67 ± 8.92 μg; P < 0.001). In addition, pain numerical rating scale (NRS) scores were significantly lower in the PSI group compared with control patients, both at rest and upon coughing within 24 postoperative hours. Postoperative adverse events were generally reduced in the PSI group compared with controls. Conclusions: USG bilateral parasternal intercostal nerve block effectively reduces postoperative pain and adjuvant analgesic requirement, with good patient satisfaction, therefore constituting a good option for mediastinal mass resection by median sternotomy.

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Perioperative analgesia during thymectomy via median sternotomy

Cited by 14 publications

References 14 publications

<p>Rasternal Intercostal Block Complementation Contributes to Postoperative Pain Relief in Modified Radical Mastectomy Employing Pectoral Nerve Block I and Serratus-Intercostal Block: A Randomized Trial</p>

<p>Rasternal Intercostal Block Complementation Contributes to Postoperative Pain Relief in Modified Radical Mastectomy Employing Pectoral Nerve Block I and Serratus-Intercostal Block: A Randomized Trial</p>

Preoperative Implementation of Transverse Thoracic Muscle Plane Block and Rectus Sheath Block Combination for Pediatric Cardiac Surgery

Ultrasound-guided Parasternal Intercostal Nerve Block for Postoperative Analgesia in Mediastinal Mass Resection by Median Sternotomy: a Randomized, Double-blind, Placebo-controlled Trial

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