The efficacy of thoracic paravertebral block for thoracoscopic surgery

Hu, Zhi; Liú, Dan; Wang, Zhizhen; Wang, Biao; Dai, Tianyang

doi:10.1097/md.0000000000013771

Cited by 27 publications

(20 citation statements)

References 32 publications

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“…Pulmonary complications represent an important group of complications after radical resection for lung cancer and can prolong the hospital stay. One retrospective study showed that general anesthesia combined with TPVB may reduce postoperative pulmonary complications [18], and other studies have shown that TPVB can shorten the postoperative hospital stay [19,20]. Our study showed that there was no difference in postoperative pulmonary complications or hospital stay between the two groups.…”

Section: Discussionsupporting

confidence: 51%

Effect of thoracic paravertebral nerve block on the early postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery

Kang

Meng

et al. 2020

World J Surg Onc

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Objective To evaluate the effect of thoracic paravertebral nerve block on early postoperative rehabilitation in patients undergoing radical thoracoscopic surgery for lung cancer. Methods Ninety patients scheduled for elective video-assisted thoracoscopic lobectomy of lung cancer were divided into 2 groups: the general anesthesia group (GA group, n = 45) and the TPVB group (TP group, n = 45). The primary outcome was the decline rate of the 6-min walking test (6MWT); the second outcomes were as follows: absolute value and the completion rate of 6MWT, postoperative analgesia deficiency and pain scores, oxycodone consumption, sleep quality, the incidence of postoperative pulmonary complications, and the hospital stay. Results Compared with the GA group, the TP group had a lower decline rate of the 6MWT on POD1 and POD2. The walking distance on POD1 and POD2 in the TP group was significantly longer than that in the GA group; the completion rate at POD1 in the TP group was higher than that in the GA group. The pain scores and oxycodone consumption at POD1 in the TP group were lower than the GA group. The sleep quality in the TP group was higher than the GA group. Conclusions TPVB can significantly improve postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery, which is helpful for promoting the early recovery of patients. Trial registration Chinese Clinical Trial Registry, ChiCTR1900026213. Registered 26 Sept. 2019, http://www.chictr.org.cn/showproj.aspx?proj=43733.

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Section: Discussionsupporting

confidence: 51%

Effect of thoracic paravertebral nerve block on the early postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery

Kang

Meng

et al. 2020

World J Surg Onc

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“… 26 The meta-analysis of Hu et al showed that the analgesic effect of TPVB after thoracotomy was lower than that of non-paravertebral block, with fewer side effects. 27 However, Hu et al did not compare TPVB with TEA, and it was unclear which analgesic method was more suitable for thoracotomy. Baidya et al conducted a meta-analysis of postoperative scores for resting and coughing pain at 4–8 hours and found that TEA and TPVB showed similar analgesic effects after thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

Liang¹,

An²,

Chen³

et al. 2021

JPR

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Background To date, there is no definitive evidence for the analgesic effects and side effects of thoracic epidural anesthesia (TEA) versus thoracic paravertebral block (TPVB) after thoracoscopic surgery. In this study, we conducted a meta-analysis of published randomized clinical trials (RCTs) to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery. Methods We systematically searched RCTs published by October 26, 2020, in PubMed, EMBASE, and Cochrane library and conducted a meta-analysis to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery. The primary measure was postoperative pain score, and the secondary measures were postoperative 24-hour usage of opioids, hypotension, postoperative nausea, and vomiting. Results A total of 458 patients from five RCTs were included in this study. After thoracoscopic surgery, the numerical rating scale (NRS) score for resting pain was higher in the TPVB group than in the TEA group at 1–2 hours and 4–6 hours after surgery (MD = 0.44, 95% CI = 0.24 to 0.64, P < 0.0001, I2 = 0%; MD = 0.47, 95% CI = 0.23 to 0.70, P < 0.0001, I2 = 0%). The postoperative 24-hour usage of morphine was higher in the TPVB group than in the TEA group (SMD = 0.67; 95% CI = 0.03 to 1.31; P = 0.04; I2 = 84%). The incidence of hypotension was significantly lower in the TPVB group than in the TEA group (OR = 4.52; 95% CI = 2.03 to 10.10; P = 0.0002; I 2 = 0%). No significant between-group difference was observed in postoperative nausea and vomiting (PONV). Conclusion Compared with TPVB, TEA provides statistically significant but clinically unimportant short-term benefits following thoracoscopic surgery.

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“…One of the first publications on paravertebral block (PVB) including a 2 year follow-up period was the 1998 report of Coveney and colleagues (39) in patients with breast cancer surgery. Since then, PVB has been used for pain control in different surgical settings, mainly after thoracic surgery (40). Norum and Breivik (41) do not consider PVB equivalent to EDA in thoracic surgery.…”

Section: Neuraxial Blocks-paravertebral Cathetersmentioning

confidence: 99%

Regional Catheters for Postoperative Pain Control: Review and Observational Data

Suksompong

Bormann

2020

Anesth Pain Med

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Context: Perioperative analgesia is an essential but frequently underrated component of medical care. The purpose of this work is to describe the actual situation of surgical patients focusing on effective pain control by discarding prejudice against 'aggressive' measures. Evidence Acquisition: This is a narrative review about continuous regional pain therapy with catheters in the postoperative period. Included are the most-relevant literature as well as own experiences. Results: As evidenced by an abundance of studies, continuous regional/neuraxial blocks are the most effective approach for relief of severe postoperative pain. Catheters have to be placed in adequate anatomical positions and meticulously maintained as long as they remain in situ. Peripheral catheters in interscalene, femoral, and sciatic positions are effective in patients with surgery of upper and lower limbs. Epidural catheters are effective in abdominal and thoracic surgery, birth pain, and artery occlusive disease, whereas paravertebral analgesia may be beneficial in patients with unilateral approach of the truncus. However, failure rates are high, especially for epidural catheter analgesia. Unfortunately, many reports lack a comprehensive description of catheter application, management, failure rates and complications and thus cannot be compared with each other. Conclusions: Effective control of postoperative pain is possible by the application of regional/neuraxial catheters, measures requiring dedication, skill, effort, and funds. Standard operating procedures contribute to minimizing complications and adverse side effects. Nevertheless, these methods are still not widely accepted by therapists, although more than 50% of postoperative patients suffer from 'moderate, severe or worst' pain.

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The efficacy of thoracic paravertebral block for thoracoscopic surgery

Cited by 27 publications

References 32 publications

Effect of thoracic paravertebral nerve block on the early postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery

Effect of thoracic paravertebral nerve block on the early postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery

The Analgesic Effects of Thoracic Paravertebral Block versus Thoracic Epidural Anesthesia After Thoracoscopic Surgery: A Meta-Analysis

Regional Catheters for Postoperative Pain Control: Review and Observational Data

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