Thoracic paravertebral blocks in abdominal surgery – a systematic review of randomized controlled trials

Abstract

Thoracic paravertebral blocks (TPVBs) have an extensive evidence base as part of a multimodal analgesic strategy for thoracic and breast surgery and have gained popularity with the advent of ultrasound guidance. However, this role is poorly defined in the context of abdominal surgery. We performed a systematic review of randomized controlled trials, to clarify the impact of TPVB on perioperative analgesic outcomes in adult abdominal surgery. We identified 20 published trials involving a total of 1044 patients that met inclusion criteria; however there was significant heterogeneity in terms of type of surgery, TPVB technique, comparator groups and study quality. Pain scores and opioid requirements in the early postoperative period were generally improved when compared with systemic analgesia, but there was insufficient evidence for any definitive conclusions regarding comparison with epidural analgesia or other peripheral block techniques, or the benefit of continuous TPVB techniques. The reported primary block failure rate was 2.8% and the incidence of complications was 1.2% (6/504); there were no instances of pneumothorax. TPVB therefore appears to be a promising analgesic technique for abdominal surgery in terms of efficacy and safety. But further well-designed and adequately powered studies are needed to confirm its utility, particularly with respect to other regional anaesthesia techniques.

Combined thoracic paravertebral and pectoral nerve blocks for breast surgery under sedation: a prospective observational case series

“…Moreover, the combined TPVB and PECS‐2 technique was highly acceptable to patients and associated with high levels of satisfaction among surgeons. Since patients received only single‐level, ultrasound‐guided TPVB, the risk of pleural puncture lower than with a multiple injection technique . The combination of TPVB and PECS‐2 also provides excellent postoperative analgesia in the majority of patients, including those undergoing mastectomy and axillary node clearance.…”

The erector spinae plane block: plane and simple

“…Thoracic paravertebral blocks have recently shown promise and an increase in clinical uptake due to the growing use of ultrasound‐guided regional anaesthesia . Their role in peri‐operative analgesic strategies in breast and thoracic surgery are well established, but the efficacy of thoracic paravertebral blocks has yet to convincingly justify their use in abdominal surgery due to a limited evidence base . The other, perhaps more pertinent barrier, is that ultrasound‐guided thoracic paravertebral block is viewed as an advanced regional anaesthetic technique, being technically challenging, time consuming, and carrying with it not insignificant risks such as pneumothorax.…”

Assessment of an ultrasound-guided technique for catheterization of the caudal thoracic paravertebral space in dog cadavers

“…The caudal thoracic paravertebral (CTPV) block is a regional anesthesia technique currently used in human medicine to provide perioperative analgesia in abdominal surgical procedures such as laparoscopic cholecystectomy, ventral hernia repair, open renal surgery, and open major gynecological midline surgery among others (Richardson et al, 1995;Naja et al, 2002;El-Boghdadly et al, 2016). The boundaries of the TPV space are the internal intercostal membrane (IIM) and costotransverse ligament dorsally, the parietal pleura (PL) ventrolaterally, and the vertebral body, intervertebral disk, and intervertebral foramen medially.…”