Thoracic Paravertebral Block for Video-Assisted Thoracoscopic Surgery: Single Injection Versus Multiple Injections

Kaya, Fatma Nur; Türker, Gürkan; Moğol, Elif Başağan; Bayraktar, Selcan

doi:10.1053/j.jvca.2011.09.008

Cited by 58 publications

(53 citation statements)

References 23 publications

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“…Of these, 22 potentially eligible articles, only 9 were found to fulfill the inclusion criteria [10]–[18]. The remaining 13 article [21]–[33] were removed because the trials did not compare PVB and EPI, or the original data were not available from the authors, or the original data was not relevant to the aims of our study. We just included 9 articles from Davies et al [9], because the results of Wedad et al included in Davies et al meta-analysis had no effect on the updated research.…”

Section: Resultsmentioning

confidence: 99%

A Comparison of the Analgesia Efficacy and Side Effects of Paravertebral Compared with Epidural Blockade for Thoracotomy: An Updated Meta-Analysis

et al. 2014

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ObjectiveThe most recent systematic review and meta-analysis comparing the analgesic efficacy and side effects of paravertebral and epidural blockade for thoracotomy was published in 2006. Nine well-designed randomized trials with controversial results have been published since then. The present report constitutes an updated meta-analysis of this issue.Summary of BackgroundThoracotomy is a major surgical procedure and is associated with severe postoperative pain. Epidural analgesia is the gold standard for post-thoracotomy pain management, but has its limitations and contraindications, and paravertebral blockade is increasingly popular. However, it has not been decided whether the analgesic effect of the two methods is comparable, or whether paravertebral blockade leads to a lower incidence of adverse side effects after thoracotomy.MethodsTwo reviewers independently searched the databases PubMed, EMBASE, and the Cochrane Library (last performed on 1 February, 2013) for reports of studies comparing post-thoracotomy epidural analgesia and paravertebral blockade. The same individuals independently extracted data from the appropriate studies.ResultEighteen trials involving 777 patients were included in the current analysis. There was no significant difference in pain scores between paravertebral blockade and epidural analgesia at 4–8, 24, 48 hours, and the rates of pulmonary complications and morphine usage during the first 24 hours were also similar. However, paravertebral blockade was better than epidural analgesia in reducing the incidence of urinary retention (p<0.0001), nausea and vomiting (p = 0.01), hypotension (p<0.00001), and rates of failed block were lower in the paravertebral blockade group (p = 0.01).ConclusionsThis meta-analysis showed that PVB can provide comparable pain relief to traditional EPI, and may have a better side-effect profile for pain relief after thoracic surgery. Further high-powered randomized trials are to need to determine whether PVB truly offers any advantages over EPI.

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Section: Resultsmentioning

confidence: 99%

A Comparison of the Analgesia Efficacy and Side Effects of Paravertebral Compared with Epidural Blockade for Thoracotomy: An Updated Meta-Analysis

et al. 2014

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“…This finding is contrary to the previous published literature when the landmark or nerve-stimulation techniques were used. 4,18 The possible reason for this is that ultrasound guidance allows precise placement of the needle tip within the paravertebral space, resulting in a widespread dermatomal coverage with a single injection. This may have implications not only for a single-shot PVB but also a continuous catheter technique because catheter insertion at multiple levels is usually not a practical approach.…”

Section: Discussionmentioning

confidence: 99%

Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks

Uppal

Sondekoppam

Sodhi

et al. 2017

Regional Anesthesia and Pain Medicine

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“…Continuous RLB has been found to be effective in controlling pain following breast cancer surgery (Juttner et al 2011;Zeballos et al 2013;Murouchi and Yamakage 2016). Some studies investigating single injections with the classical PVB have reported that a multi-level injection could provide more extensive spread of the local anesthetic than a single-level injection (Naja et al 2006;Kaya et al 2012). However, the efficacy of a single RLB injection for treating acute pain has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Analgesic Effect of Double-Level Retrolaminar Paravertebral Block for Breast Cancer Surgery in the Early Postoperative Period: A Placebo-Controlled, Randomized Clinical Trial

Onishi

Murakami

Nishino

et al. 2018

Tohoku J. Exp. Med.

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Thoracic epidural anesthesia (TEA) and paravertebral block (PVB) have been performed for perioperative regional anesthesia in the trunk. However, TEA and PVB are associated with a risk of serious complications, such as pneumothorax, hypotension, or nerve damage. Retrolaminar paravertebral block (RLB) was introduced as a new alternative to PVB. This new approach might lower the risk of serious complications, but its use has not been well established yet. Therefore, we conducted a double-masked, placebo-controlled, randomized clinical trial to evaluate the efficacy of a double-level RLB for postoperative analgesia after breast cancer surgery. A total of 122 women who underwent breast cancer surgery with axillary lymph node dissection under general anesthesia were allocated into RLB group (60 patients) and Control group (62 patients). RLB was performed upon surgery completion with 15 ml ropivacaine (0.5%) for each lamina of the T2 and T4 vertebrae. In Control group, the same volume of normal saline was injected at each level. The time to first postoperative analgesic administration was significantly longer in RLB group than that in Control group (161.5 min vs. 64.0 min). The pain score in RLB group was significantly lower immediately after surgery. However, the number of patients requiring analgesics during the 12-hour post-surgical period was similar between RLB group (20 patients) and Control group (22 patients). In conclusion, the double-level RLB could delay the time to initial administration of analgesics, but this technique may be insufficient to reduce the analgesic requirement within the 12-hour postoperative period following breast cancer surgery.

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Thoracic Paravertebral Block for Video-Assisted Thoracoscopic Surgery: Single Injection Versus Multiple Injections

Cited by 58 publications

References 23 publications

A Comparison of the Analgesia Efficacy and Side Effects of Paravertebral Compared with Epidural Blockade for Thoracotomy: An Updated Meta-Analysis

A Comparison of the Analgesia Efficacy and Side Effects of Paravertebral Compared with Epidural Blockade for Thoracotomy: An Updated Meta-Analysis

Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks

Analgesic Effect of Double-Level Retrolaminar Paravertebral Block for Breast Cancer Surgery in the Early Postoperative Period: A Placebo-Controlled, Randomized Clinical Trial

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