Ultrasound-guided thoracal paravertebral block for awake thoracoscopic lobectomy in a high-risk patient

Özen, Volkan; Derdiyok, Onur; Karacalar, Serap

doi:10.4103/jmas.jmas_106_21

Cited by 3 publications

(3 citation statements)

References 13 publications

(18 reference statements)

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“…MAP and HR can reflect the fluctuation in patient’s hemodynamics. Ozen V et al 16 showed that the use of sedative and analgesic drugs and muscle relaxants during thoracoscopic lobectomy was associated with decreased compensatory ability of patients’ circulatory changes, which can lead to the decrease in MAP and HR. Our results confirm this observation.…”

Section: Discussionmentioning

confidence: 99%

Analgesic effect of thoracic paravertebral block on patients undergoing thoracoscopic lobectomy under general anesthesia

Zeng,

Zhang,

Huang

et al. 2023

Pak J Med Sci

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Objective: To investigate the analgesic effect of thoracic paravertebral block (TPVB) in patients undergoing thoracoscopic lobectomy under general anesthesia (GA). Methods: Clinical records of 82 patients who underwent thoracoscopic lobectomy under GA from October 2021 to October 2022 in the General Hospital of Southern Theater Command were retrospectively analyzed. The patients were divided into two groups according to the method of anesthesia used: general anesthesia group (Group-G, n=37), and TPVB plus GA group (Group-T, n=45). The analgesic effect, mean arterial pressure (MAP), heart rate (HR) and the rate of adverse events in both groups were compared. Results: Visual analogue scale (VAS) scores of patients in Group-T at 12h, 24h and 48h after the operation were significantly lower compared to Group-G (P<0.05). MAP and HR the time of tracheal intubation induction (T1), single lung ventilation (T2), skin incision (T3), operation completion (T4), and 20 minutes after the extubation (T5) were lower in both groups compared to T0, and were significantly higher in Group-T compared to Group-G (P<0.05). The rate of adverse events in Group-T was 6.67%, significantly lower compared to Group-G (24.32%) (P<0.05). Conclusions: TPVB combined with GA can improve the analgesic effect, improve MAP and HR during the operation, and reduce the incidence of adverse events in patients undergoing thoracoscopic lobectomy. doi: https://doi.org/10.12669/pjms.39.6.7937 How to cite this: Zeng W, Zhang J, Huang L, Tang Z. Analgesic effect of thoracic paravertebral block on patients undergoing thoracoscopic lobectomy under general anesthesia. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.7937 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Analgesic effect of thoracic paravertebral block on patients undergoing thoracoscopic lobectomy under general anesthesia

Zeng,

Zhang,

Huang

et al. 2023

Pak J Med Sci

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“…The first published case of VATS lobectomy under awake epidural anesthesia in Turkey was presented in 2021 by Özen et al [18]. Right upper lobectomy with two ports was successfully performed by placing an epidural catheter under the guidance of ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

First awake uniportal video assisted thoracoscopic lobectomy in turkey

Karaçam,

Sagıroglu,

Karcı

et al. 2023

Curr Thorac Surg

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As in all surgical branches, the importance of minimally invasive surgery in thoracic surgery has been increasing in recent years. Especially in the last decade, the preference of thoracic surgeons is mostly in favor of VATS. As a result of today's developing technology and experience, minimally invasive surgery is not limited to surgical technique only, and less invasive non-intubated methods have been started to be used in anesthesia applications. While non-intubated (awake) VATS is usually applied for reasons such as pleural effusion, empyema, hemothorax, pneumothorax, it is now preferred for anatomical resection of the lung. We also prefer the awake VATS method in suitable patients in our clinic. In this study, we aimed to talk about our case in which we performed left lower lobectomy and mediastinal lymph node dissection with awake uVATS (uniportal VATS) method in our clinic.

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“…TPVB provides very good analgesia and reduces the required dosage of opioids without increasing the occurrence of adverse events. [30][31][32] TPVB has a good adverse event profile; hypotension is among the most common side effects. 33 In agreement with these previous findings, the TPVB+GA group consumed less propofol, sufentanil, and remifentanil, while the postoperative NRS pain score and the incidence of adverse events (shivering, nausea, and vomiting) were comparable to those in the GA group.…”

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confidence: 99%

Thoracic Paravertebral Block Decreased Body Temperature in Thoracoscopic Lobectomy Patients: A Randomized Controlled Trial

Yan¹,

Geng²,

Cui³

et al. 2023

TCRM

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Thoracic paravertebral block (TPVB) may be highly beneficial for thoracoscopic lobectomy patients, but it may increase the risk of hypothermia. Apart from its anesthetic-reducing effects, this randomized controlled trial aimed to investigate the hypothermic effect of TPVB, and thus optimize its clinical use. Patients and methods: Adult patients were randomly allocated to two groups: TPVB + general anesthesia (GA) group or GA group. In the TPVB+GA group, the block was performed after GA induction by an experienced but unrelated anesthesiologist. Both the lower esophageal and axillary temperature were recorded at the beginning of surgery (T 0 ) and every 15 min thereafter (T 1 -T 8 ), and the end of surgery (T p ). The primary outcome was the lower esophageal temperature at T p . The secondary outcomes included lower esophageal temperature from T 0 -T 8 and axillary temperature from T 0 -T p . The total propofol, analgesics, and norepinephrine consumption and the incidence of adverse events were also recorded. Results: Forty-eight patients were randomly allocated to the TPVB+GA (n=24) and GA (n=24) groups. The core temperature at the end of the surgery was lower in the TPVB+GA group than the GA group (35.90±0.30°C vs 36.35±0.33°C, P<0.001), with a significant difference from 45 min after the surgery began until the end of the surgery (P<0.05). In contrast, the peripheral temperature showed a significant difference at 60 min after the surgery began till the end (P<0.05). TPVB+GA exhibited excellent analgesic and sedativesparing effects compared to GA alone (P<0.001), though it increased norepinephrine consumption due to hypotension (P<0.001). Conclusion:Although thorough warming strategies were used, TPVB combined with GA remarkably reduced the body temperature, which is an easily neglected side effect. Further studies on the most effective precautions are needed to optimize the clinical use of TPVB.

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Ultrasound-guided thoracal paravertebral block for awake thoracoscopic lobectomy in a high-risk patient

Cited by 3 publications

References 13 publications

Analgesic effect of thoracic paravertebral block on patients undergoing thoracoscopic lobectomy under general anesthesia

Analgesic effect of thoracic paravertebral block on patients undergoing thoracoscopic lobectomy under general anesthesia

First awake uniportal video assisted thoracoscopic lobectomy in turkey

Thoracic Paravertebral Block Decreased Body Temperature in Thoracoscopic Lobectomy Patients: A Randomized Controlled Trial

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