Single-Dose, Bilateral Paravertebral Block Plus Intravenous Sufentanil Analgesia in Patients With Esophageal Cancer Undergoing Combined Thoracoscopic–Laparoscopic Esophagectomy: A Safe and Effective Alternative

Zhang, Wei; Cai, Fang; Li, Juan; Geng, Qingwei; Wang, Song; Kang, Fang; Pan, Jiang; Chai, Xiangping; Wei, Xin

doi:10.1053/j.jvca.2013.12.007

Cited by 32 publications

(31 citation statements)

References 28 publications

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“…As our results showed, TPVB had an equivalent efficacy in postoperative analgesia for PCNL as EA, which was also demonstrated for thoracic surgery [ 20 ] and breast surgery [ 21 ]; however, Elbealy et al [ 22 ] reported that lumbar paravertebral block was superior to EA for PCNL as demonstrated by lower pain scores and less systemic morphine. The 8.1 h to first demand of analgesia in patients receiving TPVB in our study was similar to the results of Hill et al [ 23 ] and Zhang et al [ 24 ], who reported a 6- to 8-hour analgesic effect after thoracoscopic procedures, and longer than the results of Ak et al [ 8 ] and Borle et al [ 9 ], who described 1.5-2 h of pain relief following PCNL.…”

Section: Discussionsupporting

confidence: 91%

Thoracic Paravertebral Block versus Epidural Anesthesia Combined with Moderate Sedation for Percutaneous Nephrolithotomy

Li¹,

Song²,

Wang³

et al. 2016

Med Princ Pract

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Objective: To investigate the feasibility of thoracic paravertebral block (TPVB) for percutaneous nephrolithotomy (PCNL) in comparison with epidural anesthesia (EA) combined with moderate sedation. Subjects and Methods: One hundred American Society of Anesthesiologists (ASA) I-II adult patients scheduled for first-stage unilateral PCNL were randomly assigned to receive either TPVB or EA. All patients were given standard sedation and analgesia with propofol and sufentanil. Patient characteristics, surgical outcomes, anesthetic outcomes, and time to first use of a patient-controlled intravenous analgesic (PCIA) device and postoperative consumption of sufentanil in the first 24 h were recorded. Intergroup differences of the parameters were analyzed using an independent t test, Mann-Whitney test, and χ² test as appropriate. Results: Patients who received TPVB consumed more propofol during ureteroscopy (56.2 ± 28.4 vs. 42.9 ± 27.5 mg, p < 0.05) and more sufentanil during ureteroscopy (9.7 ± 4.8 vs. 3.9 ± 2.7 μg, p < 0.05) and during PCNL (7.0 ± 4.3 vs. 1.9 ± 1.8 μg, p < 0.05) than those who received EA. The volume fluids infused in patients who received TPVB was less than in those who received EA (854 ± 362 vs. 1,320 ± 468 ml, p < 0.05). Time to first PCIA use, postoperative 24-hour consumption of sufentanil, and other parameters were comparable between groups. Conclusions: In this study, TPVB was as effective and safe as EA in providing intraoperative anesthesia and postoperative analgesia for PCNL, although more sedatives and analgesics were used during PCNL in patients who received TPVB.

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Section: Discussionsupporting

confidence: 91%

Thoracic Paravertebral Block versus Epidural Anesthesia Combined with Moderate Sedation for Percutaneous Nephrolithotomy

Li¹,

Song²,

Wang³

et al. 2016

Med Princ Pract

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“…Recently we started using single-dose and bilateral paravertebral block combined with sufentanil in the context of our enhanced recovery after esophagectomy program. This may provide similar postoperative analgesia and allow for early discharge avoiding the disadvantages of epidural anesthesia such as catheter malposition and hypotension [ 11 ] . The patient is intubated with a left-side double-lumen tube and is positioned in the left lateral decubitus position, tilted 45° to the prone position.…”

Section: Ramie At Umc Utrechtmentioning

confidence: 99%

Robot-assisted minimally invasive esophagectomy

Hillegersberg

Seesing

Brenkman

et al. 2016

Chirurg

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Esophagolymphadenectomy is the cornerstone of multimodality treatment for resectable esophageal cancer. The preferred surgical approach is transthoracic, with a two-field lymph node dissection and gastric conduit reconstruction. A minimally invasive approach has been shown to reduce postoperative complications and increase quality of life. Robot-assisted minimally invasive esophagectomy (RAMIE) was developed to facilitate this complex thoracoscopic procedure. RAMIE has been shown to be safe with good oncologic results and reduced morbidity. The use of RAMIE opens new indications for curative surgery in patients with T4b tumors, high mediastinal tumors, and lymph node metastases after neoadjuvant treatment. Video onlineThe online version of this article (doi:10.1007/s00104-016-0200-7) contains a video, which is available to authorized users.

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“…In contrast to epidural analgesia, paravertebral analgesia can only induce a unilateral sensory block of thoracic dermatomes. Nonetheless, this unilateral thoracic block is expected to achieve adequate control of chest pain after MIE, especially when combined with patientcontrolled intravenous opioid analgesia as an escape for breakthrough discomfort [28]. If paravertebral analgesia in fact achieves adequate pain control, the avoidance of epidural-related side-effects likely facilitates fast recovery after MIE [29,30], which is the primary interest of this study.…”

Section: Discussionmentioning

confidence: 99%

Paravertebral catheter versus EPidural analgesia in Minimally invasive Esophageal resectioN: a randomized controlled multicenter trial (PEPMEN trial)

et al. 2020

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Background: Thoracic epidural analgesia is the standard postoperative pain management strategy in esophageal cancer surgery. However, paravertebral block analgesia may achieve comparable pain control while inducing less side effects, which may be beneficial for postoperative recovery. This study primarily aims to compare the postoperative quality of recovery between paravertebral catheter versus thoracic epidural analgesia in patients undergoing minimally invasive esophagectomy. Methods: This study represents a randomized controlled superiority trial. A total of 192 patients will be randomized in 4 Dutch high-volume centers for esophageal cancer surgery. Patients are eligible for inclusion if they are at least 18 years old, able to provide written informed consent and complete questionnaires in Dutch, scheduled to undergo minimally invasive esophagectomy with two-field lymphadenectomy and an intrathoracic anastomosis, and have no contra-indications to either epidural or paravertebral analgesia. The primary outcome is the quality of postoperative recovery, as measured by the Quality of Recovery-40 (QoR-40) questionnaire on the morning of postoperative day 3. Secondary outcomes include the QoR-40 questionnaire score Area Under the Curve on postoperative days 1-3, the integrated pain and systemic opioid score and patient satisfaction and pain experience according to the International Pain Outcomes (IPO) questionnaire, and cost-effectiveness. Furthermore, the groups will be compared regarding the need for additional rescue medication on postoperative days 0-3, technical failure of the pain treatment, duration of anesthesia, duration of surgery, total postoperative fluid administration day 0-3, postoperative vasopressor and inotrope use, length of urinary catheter use, length of hospital stay, postoperative complications, chronic pain at six months after surgery, and other adverse effects. Discussion: In this study, it is hypothesized that paravertebral analgesia achieves comparable pain control while causing less side-effects such as hypotension when compared to epidural analgesia, leading to shorter postoperative length of stay on a monitored ward and superior quality of recovery. If this hypothesis is confirmed, the results of this study can be used to update the relevant guidelines on postoperative pain management for patients undergoing minimally invasive esophagectomy.

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Single-Dose, Bilateral Paravertebral Block Plus Intravenous Sufentanil Analgesia in Patients With Esophageal Cancer Undergoing Combined Thoracoscopic–Laparoscopic Esophagectomy: A Safe and Effective Alternative

Cited by 32 publications

References 28 publications

Thoracic Paravertebral Block versus Epidural Anesthesia Combined with Moderate Sedation for Percutaneous Nephrolithotomy

Thoracic Paravertebral Block versus Epidural Anesthesia Combined with Moderate Sedation for Percutaneous Nephrolithotomy

Robot-assisted minimally invasive esophagectomy

Paravertebral catheter versus EPidural analgesia in Minimally invasive Esophageal resectioN: a randomized controlled multicenter trial (PEPMEN trial)

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