Ultrasound‐guided retrolaminar paravertebral block

Zeballos, Jose; Voscopoulos, Christopher; Kapottos, M.; Janfaza, David; Vlassakov, Kamen

doi:10.1111/anae.12296

Cited by 38 publications

(30 citation statements)

References 4 publications

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“…In previous reports, an initial dose of 20-30 ml of local anesthetic was injected, followed by continuous injection or intermittent bolus injections through a catheter (Juttner et al 2011;Zeballos et al 2013;Voscopoulos et al 2013;Yoshida et al 2015;Murouchi and Yamakage 2016). In the current study, we attempted to provide postoperative analgesia with an initial dose of local anesthetic.…”

Section: Discussionmentioning

confidence: 99%

“…However, the distribution of local anesthetic injected during RLB has been unclear. Several case reports have shown the efficacy of RLB for breast cancer surgery (Juttner et al 2011;Zeballos et al 2013) and rib fracture Yoshida et al 2015). Local anesthetics injected upon the laminae were assumed to penetrate the PVS.…”

Section: Discussionmentioning

confidence: 99%

“…The RLB needle should contact the lamina, upon which the local anesthetic is injected. 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).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…A variant of technique similar to erector spinae block is the retrolaminar block and which may have potential to provide analgesia by reaching the paravertebral space . This involves the injection of local anesthetic medicine into the musculofascial plane between the paraspinal muscle and lamina of the underlying vertebrae.…”

Section: Erector Spinae Blockmentioning

confidence: 99%

Regional anesthesia for sternotomy and bypass—Beyond the epidural

Raj

2019

Pediatric Anesthesia

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Summary Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution, and duration of pain in these children have not been studied as extensively as in adults. Currently, there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response while minimizing their unwanted side effects. At present there is a tendency to use lower dose aiming for early extubation and minimize opioid‐related side effects, but this may not obtund the stress response in all children. The development of chronic pain although rare when compared to adults is still a risk that needs further investigation. Regional anesthetic techniques, by blocking the afferent impulses, have been shown to be advantageous in reducing the stress response to surgery as well as pain and opioid requirements in children up to 24 hours after cardiac surgery. Central neuraxial blockades have not gained wide spread acceptance in these procedures due to the worry of hematoma, although rare, leading to catastrophic neurological outcomes. This review focuses on blocks outside the vertebral column, ie, peripheral nerve blocks, performed either in the front or the back of the chest wall to target the thoracic intercostal nerves. Techniques of ultrasound‐guided bilateral single shot paravertebral block and erector spinae block posteriorly and transversus thoracic plane block anteriorly are discussed. In addition, parasternal block and wound infiltration by surgeon as well as continuous local anesthetic infusion via catheters placed at end of procedures are summarized. Current evidence available for use of these techniques in children undergoing cardiac surgery are reviewed. These are based on small studies and case series and further studies are required to evaluate the risks and benefits of local anesthetic blocks in children undergoing cardiac surgery.

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“…Successful use of the RB has been reported for analgesia in major breast surgery, rib fractures, transcatheter aortic valve implantation, lumbar trauma, and lumbar laminoplasty. [6][7][8][9][10][11][12][13] Analgesia in RB is postulated to occur by blockade of thoracic spinal nerves; however, the pattern of LA spread and the mechanism of spinal nerve blockade with this technique are unknown. We hypothesized that spinal nerve blockade could occur by spread of LA to the TPVS, epidural space, and/or intervertebral foramina.…”

mentioning

confidence: 99%