Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial

Pei, Lijian; Zhou, Yidong; Tan, Gang; Mao, Feng; Yang, Dongsheng; Guan, Jinghong; Yang, Lin; Wang, Xuejing; Zhang, Yanna; Zhang, Xiaohui; Shen, Songjie; Xu, Zhendong; Sun, Qiang; Huang, Yuguang

doi:10.1371/journal.pone.0142249

Cited by 28 publications

(22 citation statements)

References 35 publications

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“…Our non‐inferiority margin of 0‐100 µg can be considered appropriate as Naik et al observed that a median dose of 350 µg of fentanyl was used in their study comparing dexmedetomidine versus saline . Another study also observed a median difference in intraoperative fentanyl requirement of 150 µg to be non‐inferior between paravertebral block with propofol group and general anaesthesia group …”

Section: Discussionmentioning

confidence: 92%

Comparison of intraoperative fentanyl with dexmedetomidine for perioperative analgesia and opioid consumption during craniotomies: A randomised controlled pilot study with non‐inferiority design

et al. 2019

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Background: Moderate to severe pain is common despite the use of potent opioids during craniotomies. Non-opioid agents such as dexmedetomidine reduce undesirable opioid effects and are successfully used as primary analgesic during bariatric surgeries. This study assessed the feasibility of conducting a large randomised controlled trial comparing fentanyl with dexmedetomidine for perioperative analgesia during craniotomy. Methods:This was a prospective single-centre randomised controlled feasibility trial.Twenty-four consenting adult patients undergoing supratentorial craniotomy at NIMHANS, Bangalore, India, were recruited after ethical approval in March and April 2018. They received either fentanyl 1 µg kg −1 h −1 (n = 12) or dexmedetomidine 0.5 µg kg −1 h −1 (n = 12) as primary intraoperative analgesic drug. Patient, anaesthesiologist, outcome assessor and data analyst were blinded to the study intervention.Our feasibility outcomes (primary) were recruitment and adherence rates. We also explored the potential efficacy of intervention and adverse events. Results:We recruited 24 out of 30 eligible patients and had 100% protocol adherence, thereby demonstrating the feasibility of a larger randomised controlled trial. All 24 patients completed the study. The demographic and clinical parameters were similar between the groups. Compared between fentanyl and dexmedetomidine, there was no difference in the intraoperative fentanyl (top-up) consumption (µg), expressed as median and interquartile range: 25 (0-50) and 0 (0-50); P = 0.844; and no difference in postoperative pain at 15 and 60 minutes. Adverse events were few and similar with fentanyl and dexmedetomidine. Conclusions:A large-scale randomised controlled trial of perioperative dexmedetomidine versus fentanyl is feasible. Dexmedetomidine has the potential to be non-inferior to fentanyl for perioperative analgesia during craniotomies.

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Section: Discussionmentioning

confidence: 92%

Comparison of intraoperative fentanyl with dexmedetomidine for perioperative analgesia and opioid consumption during craniotomies: A randomised controlled pilot study with non‐inferiority design

et al. 2019

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“…This space includes spinal and sympathetic nerves and their block provides effective anesthesia in the management of thoracic and/or abdominal pain after various types of surgery [ 3 ]. The application of PVB has been shown to improve pain scores and decrease analgesic drug requirements, postoperative nausea, and vomiting [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Ultrasound-Guided Paravertebral Block in Laparoscopic Cholecystectomy

Aydın

2018

Medicina

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Background and objectives: Despite its wide use in thoracic procedures, to date, few studies have assessed the effectiveness of paravertebral block (PVB) in laparoscopic cholecystectomy (LC) in an adult population. In these studies, PVB was performed bilaterally using nerve stimulator guidance. To the best of our knowledge, the effectiveness of unilateral preoperative and postoperative ultrasound-guided PVB has not been evaluated in patients undergoing elective LC. The aim of this study was to evaluate the efficacy of single-dose unilateral paravertebral block (PVB) in patients undergoing laparoscopic cholecystectomy (LC) under general anesthesia. Materials and Methods: Patients undergoing LC were randomly separated into control, preoperative block, and postoperative block groups. PVB was performed unilaterally using bupivacaine under ultrasound guidance. Postoperative pain within the first 24 h, side effects, intraoperative opioid and postoperative analgesic requirements were noted. Evaluation was made of a total of 90 patients (25 males, 65 females) with a mean age of 45.78 ± 14.0 years (range, 19–74 years). Results: Opioid and additional analgesic needs and nausea/vomiting rates were significantly reduced in the preoperative block group compared to the other groups (p < 0.05). Visual Analog Scale (VAS) scores were significantly lower in the preoperative and postoperative block groups compared to the control group (p < 0.05 for all). When the VAS scores were compared between the preoperative and postoperative block groups, a significant difference in favor of the preoperative group was observed in terms of the zero minute-, 1st and 2nd h assessments (p < 0.05 for all). Conclusions: Ultrasound-guided PVB is a useful and safe approach for pain management during and after LC. Preoperative block can also reduce the rate of requirement for intraoperative opioid and postoperative analgesia.

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“…Regional anaesthesia has been used and studied extensively in breast surgery as an opioid‐sparing strategy, with block of the intercostal supply by thoracic paravertebral block (TPVB) becoming a popular technique . New fascial plane blocks have been developed as alternative or supplementary techniques for chest wall analgesia, including the pectoral nerve blocks (PECS 1 and PECS 2) and serratus plane block .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Avoidance of general anaesthesia for breast surgery may be because of clinical reasons or patient choice. There is emerging evidence that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes. We conducted a prospective observational case series of 16 breast cancer surgeries performed under thoracic paravertebral plus pectoral nerve block with propofol sedation to demonstrate feasibility of technique, patient acceptability and surgeon satisfaction. Fifteen out of 16 cases were successfully completed under sedation and regional anaesthesia, with one conversion to general anaesthesia. Eleven out of 16 cases required low-dose intra-operative opioid analgesia. Out of the 15 surgical procedures completed under regional anaesthesia with sedation, all patients experienced either no or minimal intra-operative pain, and all would choose this anaesthetic technique again. Surgeon-reported operating conditions were 'indistinguishable from general anaesthesia' in most cases, and surgeons were 'extremely satisfied' or 'satisfied' with the technique after every procedure. Combined thoracic paravertebral plus pectoral nerve block with intra-operative sedation is a feasible technique for breast surgery.

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Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial

Cited by 28 publications

References 35 publications

Comparison of intraoperative fentanyl with dexmedetomidine for perioperative analgesia and opioid consumption during craniotomies: A randomised controlled pilot study with non‐inferiority design

Comparison of intraoperative fentanyl with dexmedetomidine for perioperative analgesia and opioid consumption during craniotomies: A randomised controlled pilot study with non‐inferiority design

The Efficacy of Ultrasound-Guided Paravertebral Block in Laparoscopic Cholecystectomy

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

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