Safety, complications and clinical outcome after ultrasound‐guided paravertebral catheter insertion for rib fracture analgesia: a single‐centre retrospective observational study

Womack, Jonathan; Pearson, Jon; Walker, Isabeau; Stephens, Nicola; Goodman, Ben

doi:10.1111/anae.14580

Cited by 29 publications

(17 citation statements)

References 30 publications

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“…We did not place the catheter in the paravertebral space for both the technical reasons and the risk of catheter-related complications. 37 Consistent with the results of the previous study, patients in the P group tended to have better pain control. Different kinds and concentrations of drugs, the injection numbers for PVB, and the detailed methods and procedures of VATS may explain this significant heterogeneity.…”

Section: Discussionsupporting

confidence: 90%

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

Yang¹,

Hao²,

Li³

et al. 2020

JPR

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Background: Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS. Methods: Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery. Results: VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P<0.05). Conclusion: PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.

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Section: Discussionsupporting

confidence: 90%

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

Yang¹,

Hao²,

Li³

et al. 2020

JPR

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“…Data from our experiences reveal an extremely low complication rate, with no significant complications from 314 paravertebral catheters over a 4‐year period , inserted by consultant and registrar anaesthetists. This is consistent with our experience of thousands of single‐shot blocks performed for breast surgery, and with similar experiences in other centres worldwide . We recognise that there is, undoubtedly, a learning curve associated with the paravertebral technique, but we believe this is similar in appearance to learning curves for any other new regional anaesthetic technique.…”

supporting

confidence: 88%

Erector spinae plane vs. paravertebral blockade for rib fracture analgesia

2019

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We would like to commend Adhikary et al. for their continued efforts to show benefit from novel regional techniques for chest trauma [1] and agree that patients with rib fracture(s) have significantly improved pain scores after regional analgesia. We would like to invite the authors to reply to a number of comments that we have about their work.Firstly, the authors make several comments about the technically challenging nature of paravertebral blockade. In our institution, ultrasound-guided thoracic paravertebral blockade is the regional technique of choice in unilateral chest trauma. Data from our experiences reveal an extremely low complication rate, with no significant complications from 314 paravertebral catheters over a 4-year period [1], inserted by consultant and registraranaesthetists. This is consistent with our experience of thousands of single-shot blocks performed for breast surgery, and with similar experiences in other centres worldwide [2]. We recognise that there is, undoubtedly, a learning curve associated with the paravertebral technique, but we believe this is similar in appearance to learning curves for any other new regional anaesthetic technique.Secondly, we note that only 79 patients were administered an erector spinae plane (ESP) block over 19 months. Can we ask whether there were other patients in the authors' institution that received epidural or paravertebral blockade during this time, and whether comparative analysis has been possible? We are not aware of any published evidence that the ESP block is technically easier, and the results of any such analysis would be useful to know when organising training. Are there novices or nonanaesthetists performing the ESP block at the authors' institution? Thirdly, the authors question the feasibility of paravertebral blockade in coagulopathy and haemodynamic instability. In our opinion, neither coagulopathy nor anticoagulation is a contra-indication to paravertebral techniques, necessarily. We assess each case individually, in line with the collaborative guideline from on regional anaesthesia techniques in patients with abnormalities of coagulation [3]. This guideline classifies paravertebral block as 'higher risk' compared with more peripheral or superficial techniques, but provides no quantification of this risk, and does not reference any evidence documenting complications in patients with disorders of coagulation. Furthermore, we can find no case reports of spinal or epidural haematomas following ultrasound-guided paravertebral block performance. The practice of using curled catheters rather than straight in the paravertebral space further reduces the risk of accidental epidural placement. Our experience also reveals no associated haemodynamic instability following paravertebral blockade. Their analysis revealed a statistically significant increase in spirometry values, but such improvement would be expected normally over time, with or without regional anaesthesia. Are the authors confident about ascribing causality between the block and the...

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“…The role of regional analgesia for fracture analgesia is well‐recognised. It has been shown to improve the outcomes of patients with neck of femur and rib fractures . Although we report a novel indication, ultrasound‐guided sacral plexus blocks have been described for surgical anaesthesia of the hip joint in conjunction with a lumbar plexus block .…”

Section: Discussionmentioning

confidence: 93%

Sacral plexus catheter analgesia in a patient with traumatic sacral fractures and Tarlov cysts

Ireland

Womack

Foley

2019

Anaesthesia Reports

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Summary We report the use of a sacral plexus catheter for continuous local anaesthetic infusion in a patient with a unilateral sacral ala fracture following a fall from a horse. Although sacral plexus blockade has been well described for lower limb surgery, an ultrasound‐guided continuous catheter technique for conservatively managed fractures has not been described. Despite appropriate oral analgesia, the patient reported severe pain, particularly in the right gluteal region, which meant she was unable to sit upright or take deep breaths. A sacral plexus catheter was inserted with ultrasound guidance and an initial bolus of 30 ml levobupivicaine 0.25% was delivered followed by infusion of 8 ml.h−1 levobupivicaine 0.125%. Daily follow‐up and assessment were provided by the acute pain team. We judged the procedure to be a success as measured by an improvement in mobilisation, deep breathing, cough and patient satisfaction.

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Safety, complications and clinical outcome after ultrasound‐guided paravertebral catheter insertion for rib fracture analgesia: a single‐centre retrospective observational study

Cited by 29 publications

References 30 publications

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

Erector spinae plane vs. paravertebral blockade for rib fracture analgesia

Sacral plexus catheter analgesia in a patient with traumatic sacral fractures and Tarlov cysts

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