Thoracic Paravertebral Block: Influence of the Number of Injections

Naja, Zoher; El-Rajab, Mariam; Al-Tannir, Mohamad; Ziade, Fouad; Tayara, Khalil; Younes, Fadi; Lönnqvist, Per‐Arne

doi:10.1016/j.rapm.2005.12.004

Cited by 82 publications

(82 citation statements)

References 25 publications

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“…Both unilateral and bilateral thoracic paravertebral blocks are used to provide analgesia and anesthesia for breast surgery and may be performed at one or more vertebral levels [82]. Injecting at multiple thoracic levels increases the number of affected dermatomes and improves analgesia duration/quality, but subjects the patient to a higher risk of complications [13, [83][84][85]. In contrast, a single injection improves patients' comfort and requires less sedation to be administered during the block, resulting in higher patient satisfaction [16,86], but carries the theoretical increased risk of bilateral neuraxial spread.…”

Section: Paravertebral Nerve Blocks: Anatomy and Techniquementioning

confidence: 99%

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

Cheng

2016

Pain Med

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Objective. To review the published evidence regarding perioperative analgesic techniques for breast cancer-related surgery.Design. Topical review.Methods. Randomized, controlled trials (RCTs) were selected for inclusion in the review. Also included were large prospective series providing estimates of potential risks and technical reports and small case series demonstrating a new technique or approaches of interest to clinicians.Results. A total of 514 abstracts were reviewed, with 284 studies meeting criteria for full review. The evidence regarding preemptive ketamine, scheduled opioids, perioperative non-steroidal anti-inflammatory drugs (NSAIDs), and intravenous lidocaine is mixed and deserves further investigation. There is strong evidence that both pregabalin and gabapentin provide analgesic benefits following breast surgery. There is minimal and conflicting data from highquality randomized, controlled studies suggesting that directly infiltrating and/or infusing local anesthetic (liposome encapsulated or unencapsulated) into the surgical wound is a reliably effective analgesic. In contrast, there is a plethora of data demonstrating the potent analgesia, opioid sparing, and decreased opioid-related side effects from thoracic epidural infusion and both single-injection and continuous paravertebral nerve blocks (the latter two demonstrating decreased persistent post-surgical pain between 2.5 and 12 months). Techniques with limited-yet promising-data deserving additional investigation include brachial plexus blocks, cervical epidural infusion, interfascial plane blocks, and interpleural blocks.Conclusions. While there are currently multiple promising analgesic techniques for surgical procedures of the breast that deserve further study, the only modalities demonstrated to provide potent, consistent perioperative pain control are thoracic epidural infusion and paravertebral nerve blocks.

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Section: Paravertebral Nerve Blocks: Anatomy and Techniquementioning

confidence: 99%

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

Cheng

2016

Pain Med

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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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“…We used a multilevel injection PVB which has been shown to produce a more reliable sensory block than a single injection technique. 23 Drugs used for PVB include bupivacaine, ropivacaine, and levobupivacaine with or without epinephrine. In our study, bupivacaine 0.5% was used, as it is more readily available and less expensive.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Paravertebral Block, a Suitable and Safe Adjunct for General Anaesthesia, for Post-Operative Pain Relief in Modified Radical Mastectomies

Sasikumar¹

2018

jmscr

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Thoracic Paravertebral Block: Influence of the Number of Injections

Abstract: The main finding of the present study was that multiple paravertebral injections resulted in more reliable radiographic and clinical distribution compared with a single-injection technique.

Cited by 82 publications

References 25 publications

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

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

Thoracic Paravertebral Block, a Suitable and Safe Adjunct for General Anaesthesia, for Post-Operative Pain Relief in Modified Radical Mastectomies

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