Preemptive Intercostal Nerve Block as an Alternative to Epidural Analgesia

Yamazaki, Shiori; Koike, Sachie; Eguchi, Takashi; Matsuoka, Shunichiro; Takeda, Teiji; Miura, Kentaro; Hamanaka, Kazutoshi; Shimizu, Kimihiro

doi:10.1016/j.athoracsur.2021.07.019

Cited by 10 publications

(10 citation statements)

References 25 publications

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“…The neuromuscular blockade was reversed and the patient was extubated if awake. After extubation, patients had intravenous patient-controlled analgesia (PCA) via an infusion pump to deliver oxycodone at an infusion rate of ( 16 – 18 ) mcg/kg/h and a bolus dose of 1.5 mg with a lockout time of 15 min during the first 48 h postoperatively.…”

Section: Methodsmentioning

confidence: 99%

“…With the rapid advancement of ultrasound use in recent years, ultrasound-guided, thoracic paravertebral block (TPVB) has been shown to increase the success rate of block significantly (15). Several systemic reviews suggested that both TPVB and intercostal nerve blocks (ICNB) could play a role in ameliorating post-thoracotomy pain (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

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Effect of Preoperative Thoracic Paravertebral Blocks on Emergence Agitation During Tracheal Extubation: A Randomized Controlled Trial

Liu

Luo²,

Wang³

et al. 2022

Front. Med.

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ObjectiveThis study aims to compare the effects of preoperative thoracic paravertebral blocks (TPVB) with intercoastal nerve blocks (ICNB) on emergence agitation (EA) during tracheal extubation in patients who underwent thoracoscopic lobectomy.Design, Setting, and ParticipantsA randomized clinical trial was conducted in patients undergoing thoracoscopic lobectomy at Beijing Chest Hospital between June 2019 and December 2020.InterventionsPatients were randomly assigned 1:1 to receive either ultrasound-guided preoperative TPVB or ICNB.Main Outcomes and MeasuresThe primary outcome was the occurrence of emergency agitation, which was evaluated by Aono’s four-point scale (AFPS). Secondary outcomes included hemodynamics [mean arterial pressure (MAP) and heart rate (HR)]; and post-operative pain intensity [visual analog scale (VAS), Ramsay sedation score (RSS), and patient-controlled analgesia (PCA) demand times].ResultsAmong the 100 patients aged 55–75 years old, 50 were randomized to each group; 97 patients completed the trial. Compared to the ICNB group, the occurrence of EA in the TPVB group was significantly lower [31.3% (15/48) vs. 12.2% (6/49), relative risk = 1.276, 95% CI: 1.02–1.60, P = 0.028]. For patients in the TPVB group, the MAP and HR at 5, 10, and 30 min after extubation were significantly lower; the intraoperative details including emergence time, extubation time, and consumption of sufentanil were significantly shorter than that in the ICNB group. Additionally, patients in the TPVB group showed significantly lower VAS at rest or coughing and significantly lower RSS at 60 and 240 min after extubation than patients in the ICNB group (all P < 0.05).ConclusionPreoperative TPVB was associated with less EA during tracheal extubation when compared with ICNB in patients undergoing thoracoscopic lobectomy.Clinical Trial Registration[http://www.chictr.org.cn/index.aspx], identifier [ChiCTR1900023852].

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Preoperative Thoracic Paravertebral Blocks on Emergence Agitation During Tracheal Extubation: A Randomized Controlled Trial

Liu

Luo²,

Wang³

et al. 2022

Front. Med.

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“…Mini-review: ICNB, as a quick and simple procedure, is an alternative method to continuous epidural anesthesia in analgesic care [ 42 ]. In addition, the modification of the execution of the technique by changing the location of the anesthetic infiltration was described [ 15 ].…”

Section: Local Thoracic Plain Blocks—review Of Techniquesmentioning

confidence: 99%

“…Techniques such as PECS, SAP, TTP, and PIF blocks can be used as the only method of anesthesia and postoperative pain management for selected procedures [ 6 , 7 , 8 , 16 , 53 , 54 , 55 , 56 , 57 , 58 ]. The intercostal nerve block is mainly used for pain management [ 38 , 42 ].…”

Section: Interfascial Plane Blocks and The Covid-19 Approachmentioning

confidence: 99%

Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic

Szamborski

Janc

Rosińczuk

et al. 2022

IJERPH

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Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.

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“…After this protocol was implemented, between June proactively conducted due to their high risk of conversion (we generally do not provide epidural analgesia for MIS 11 ). There were no emergency conversions after the initiation of this protocol.…”

Section: Mismentioning

confidence: 99%

Prediction of Pulmonary Artery-Adherent Lymph Nodes for Minimally Invasive Lung Resection

Takeda

Matsuoka

Miura

et al. 2022

The Annals of Thoracic Surgery

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Preemptive Intercostal Nerve Block as an Alternative to Epidural Analgesia

Cited by 10 publications

References 25 publications

Effect of Preoperative Thoracic Paravertebral Blocks on Emergence Agitation During Tracheal Extubation: A Randomized Controlled Trial

Effect of Preoperative Thoracic Paravertebral Blocks on Emergence Agitation During Tracheal Extubation: A Randomized Controlled Trial

Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic

Prediction of Pulmonary Artery-Adherent Lymph Nodes for Minimally Invasive Lung Resection

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