Search

Background: Erector spinae plane block (ESPB) is a promising technique for effective analgesia. It is still uncertain if ESPB offers the same opioid-sparing effect as thoracic paravertebral block (PVB) in midline incision for upper abdominal surgery. Methods: The study is a prospective, bi-center, randomized, controlled, non-inferior trial. One hundred fifty-eight patients scheduled for upper abdominal surgery will be randomly assigned to receive bilateral ESPB or PVB before surgery. The primary outcome will be the equivalent cumulative analgesia dosage of sufentanil during the surgery, which is defined as the total dosage of sufentanil from anesthesia induction to tracheal extubation. The main secondary outcomes include postoperative complications and the quality of recovery-15 score at 24 h, 48 h, and 30 days after surgery. Discussion: This study will assess the opioid-sparing efficacy of ESPB and PVB, complications, and the quality of recovery of two blocks. Trial registration: ChiCTR2300073030 (https://www.chictr.org.cn/). Registered on 30 June 2023. [ABSTRACT FROM AUTHOR]

Abstract Background Erector spinae plane block (ESPB) is a promising technique for effective analgesia. It is still uncertain if ESPB offers the same opioid-sparing effect as thoracic paravertebral block (PVB) in midline incision for upper abdominal surgery. Methods The study is a prospective, bi-center, randomized, controlled, non-inferior trial. One hundred fifty-eight patients scheduled for upper abdominal surgery will be randomly assigned to receive bilateral ESPB or PVB before surgery. The primary outcome will be the equivalent cumulative analgesia dosage of sufentanil during the surgery, which is defined as the total dosage of sufentanil from anesthesia induction to tracheal extubation. The main secondary outcomes include postoperative complications and the quality of recovery-15 score at 24 h, 48 h, and 30 days after surgery. Discussion This study will assess the opioid-sparing efficacy of ESPB and PVB, complications, and the quality of recovery of two blocks. Trial registration ChiCTR2300073030 ( https://www.chictr.org.cn/ ). Registered on 30 June 2023.

Background and Aims: The erector spinae plane block (ESPB) is a novel regional anesthesia technique compared to the thoracic paravertebral block (TPVB) in providing postoperative pain relief in breast surgeries. Modified radical mastectomy (MRM) is a commonly performed surgery for breast cancer. The objective of the study is to compare the efficacy of ESPB and TPVB in providing postoperative pain relief after MRM. Material and Methods: This is a prospective randomized study conducted in a tertiary care teaching hospital. Sixty ASA I–III adult patients (age >18 years) scheduled to undergo elective unilateral MRM for breast cancer were enrolled in the study. Ultrasound-guided ESPB or TPVB with 0.25% bupivacaine was performed preoperatively on the patients randomized into two groups, namely, the ESPB and TPVB groups. All patients received patient-controlled analgesia for postoperative pain relief. Morphine consumption and Visual Analog Score (VAS) for pain were recorded at 3, 6, 12, and 24 h postoperatively. Results: Primarily, the mean postoperative VAS scores between the two groups at 3, 6, 12, and 24 h showed no statistical significance and were comparable when matched at different time points. However, 24-h morphine consumption was significantly more in the ESPB group (P = 0.035). Duration of block performance also showed a significant difference, with ESPB taking less time to perform (P < 0.001). The mean age and body mass index (BMI) of patients and length of hospital stay in both the groups were similar. Conclusions: Both ESPB and TPVB provided adequate analgesia in patients undergoing MRM; however, TPVB had better efficacy and opioid-sparing effect when compared to ESPB.

Background and Aims: The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. Paravertebral block (PVB) and erector-spinae block (ESPB) are two novel techniques for treating this distressing condition. We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ). Material and Methods: Sixty patients in pain due to AHZ were selected for a prospective randomized control study after approval from Institutional Ethical Committee. Written informed consent was taken. Patients were randomized and allotted into Control-group: standard treatment (oral antivirals, analgesics, neuropathic medicines); PVB-Group: standard treatment with PVB and ESPB- Group: standard treatment with ESPB. Under ultrasound guidance, both blocks were administered with 20 ml of 0.25% bupivacaine + dexamethasone 8 mg. Efficacy was evaluated on the 15th, 30th, and 60th day post treatment. The primary endpoint was the proportion of patients with adequate relief from pain and allodynia post study. Results: The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). The proportion of patients with pain relief was higher among the PVB group compared to the ESPB group but not statistically significant (p 0.749). On day 60, the mean pain score was 2.45 (±3.05) and 2.15 (±2.7) in ESPB and PVB groups, respectively, and 4.3 (±2.27) in the control group (p 0.003). Conclusion: PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN.

The objective was to analyze the literature on modern approaches to the choice of regional anesthesia method for thoracoscopic surgical interventions. Materials and methods. A review of the most common approaches to the choice of regional anesthesia method for thoracoscopic surgical interventions was carried out.Results. The analysis of the literature has shown that to date, in the practice of an anesthesiologist and intensivist, there is no single standard for anesthesia of patients during and after thoracoscopic operations, but the use of regional anesthesia methods can increase the positive effects of minimally invasive methods, which include video-assisted thoracoscopic surgeries (VATS). Further studies comparing the efficacy of regional anesthesia methods in thoracic surgery are needed.Conclusion. At the moment, the evidence collected in the world specialized literature confirms that thoracic epidural analgesia (TEA), paravertebral block, erector spinae plane block, and serratus anterior plane block can be considered comparatively effective methods of regional anesthesia in VATS. Meanwhile, high-quality comparative clinical studies that allow us to choose the most effective and safe method of regional anesthesia are limited.

Background/Objectives: The paravertebral block (PVB) is a well-studied, effective method of analgesia for breast surgery. Alternative techniques involving the blockage of intercostal nerve branches are the serratus anterior plane block (SAPB) and the erector spinae plane block (ESPB). However, no studies comparing both fascial blocks to PVB in breast surgery have been published to date. We evaluated the effectiveness of ESPB and SAPB vs. PVB, expressed as the requirement for intraoperative fentanyl, pain intensity at rest and during coughing, and morphine consumption on the first postoperative day. Additional aims were to perform an evaluation of the safety of the block types used. Materials and Methods: A total of 77 women and 1 man with stage I and II clinical breast cancer, aged 18–85 years, were randomized into one of three study groups: SAPB, PVB, and ESPB. Results: There were no statistically significant differences in fentanyl consumption during surgery with respect to the type of block used (p = 0.4246). Morphine consumption in the postoperative period was highest in the ESPB group, averaging 9.4 mg. There was a statistically significant difference in pain intensity from 4 pm on the day of surgery to 8 am the following morning. No complications related to the blocks were observed on the first postoperative day. Conclusions: Both the serratus anterior plane block and the erector spinae plane block were as effective as the paravertebral block in achieving intraoperative analgesia. The serratus anterior plane block was equally as effective as the paravertebral block in achieving postoperative analgesia. The erector spinae plane block was significantly less effective in achieving postoperative analgesia than both the paravertebral block and serratus anterior plane block. [ABSTRACT FROM AUTHOR]

Background & aim Paravertebral block (PVB) is a commonly used technique, for postoperative analgesia after modified radical mastectomy(MRM).Though many adjuvants to bupivacaine in PVB have been tried for postoperative analgesia, none has been found ideal. We have compared the duration of analgesia in PVB using adjuvant like dexmedetomidine and nalbuphine with bupivacaine after MRM. Methods Sixtyfive female patients posted for MRM were divided into two groups. Group BN received ultrasound guided PVB with 20 ml bupivacaine 0.25% with nalbuphine 10mg and Group BD received 20 ml bupivacaine 0.25% with dexmedetomidine 1 μg/kg. After confirming PVB, surgery was done under general anesthesia in all patients. Time for 1st rescue analgesic request was the primary aim of our study. Secondary aim of our study was numerical rating scores (NRS) for pain at rest and on movement and total analgesic consumption. Side effects like nausea and vomiting,hemodynamics and sedation in post operative 24 hrs were also assessed. Results The time of the first rescue analgesic requirement was prolonged in the group BD (7.32 ± 1.75 hours) in contrary to group BN (4.94 ± 2.12 hours). The mean total paracetamol consumption as rescue analgesia in the in the first 24 hours postoperatively was significantly reduced in group BD (2.7 ±0.94 gm) in contrary to group BN (3.6 ± 0.98 gm). (p<0.001) Decrease in hear rate and mean arterial pressure was more in BD group compared to BN group intraoperatively. (p<0.001) Conclusion Dexmedetomidine provides prolonged analgesia when used as additive to bupivacaine in PVB for modified radical mastectomy compared to nalbuphine. [ABSTRACT FROM AUTHOR]

Background Perioperative thoracic epidural analgesia (TEA) is commonly used in hepatectomy patients since it is opioid-sparing. However, TEA has a high failure rate and is associated with potentially devastating complications (spinal haematoma) and the risk is increased with hepatectomy. Thus, some centres favour systemic opioid-based modalities which, in turn, are associated with inferior analgesia and well-known risks/side-effects. Hence, alternative analgesic methods are desirable. Paravertebral block (PVB) has been used in liver resection with advantages including haemodynamic stability, low failure rates, and low risk of spinal haematoma. The purpose of this pilot RCT is to compare continuous TEA (traditional standard of care is local anesthetic (LA) + opioids) with PVB (traditional standard of care is with LA without opioid) for patients undergoing hepatectomy. We hypothesise that pain outcomes will be comparable between groups, but PVB patients will require fewer perioperative vasopressors/blood products, have fewer opioid-related side effects and a shorter hospital length of stay. Methods With ethics approval, this non-inferiority, pilot RCT with a convenience sample of 50 hepatectomy patients will examine whether PVB imparts analgesia comparable to TEA but with fewer adverse effects. Primary outcomes are surrogates of analgesia for 72 h postoperatively (i.e., opioid consumption, time to first analgesic request and pain scores at rest and with coughing); Secondary outcomes are blood products/fluids administered; side effects/complications until 72 h postoperatively; length of hospital stay. The results will be used to plan a large multicentre trial comparing TEA vs. PVB in hepatectomy patients. This study has a high potential to positively impact the quality/safety of patient care. ClinicalTrials.gov registration NCT02909322 (09-21-2016); Available at URL: https://clinicaltrials.gov/ct2/show/NCT0290932

Background Perioperative thoracic epidural analgesia (TEA) is commonly used in hepatectomy patients since it is opioid-sparing and reduces cardiorespiratory complications. However, TEA has a high failure rate and is associated with potentially devastating complications (particularly spinal haematoma) and the risk is increased with hepatectomy. Thus, some centres favour systemic opioid-based modalities which, in turn, are associated with inferior analgesia and well-known risks/side-effects. Hence, alternative analgesic methods are desirable. Paravertebral block (PVB) has been used in liver resection with advantages including haemodynamic stability, low failure rates, and low risk of spinal haematoma. Our purpose is to conduct a blinded, pilot RCT with hepatectomy patients randomised to receive TEA or PVB for perioperative analgesia. We hypothesise that opioid consumption, time to first analgesic request, and pain scores will be comparable between groups, but PVB patients will require fewer perioperative vasopressors/blood products, and have fewer adverse events and a shorter hospital stay. Methods With ethics approval, this non-inferiority, pilot RCT with a convenience sample of 50 hepatectomy patients will examine whether PVB imparts analgesia comparable to TEA but with fewer adverse effects. Primary outcomes are surrogates of analgesia for 72 h postoperatively (i.e., opioid consumption, time to first analgesic request and pain scores at rest and with coughing); Secondary outcomes are blood products/fluids administered; side effects/complications until 72 h postoperatively; length of hospital stay. The results will be used to plan a large multicentre trial comparing TEA vs. PVB in hepatectomy patients. This study has a high potential to positively impact the quality/safety of patient care. ClinicalTrials.gov registration NCT02909322 (09-21-2016); Available at URL: https://clinicaltrials.gov/ct2/show/NCT0290932

Scapular surgery has mainly been studied in the setting of fractures; regional anesthesia can be utilized as part of a multimodal analgesia regimen for postoperative pain relief. Previous studies are limited to scapular fracture pain. The available literature supports the use of various types of nerve blocks and even combinations of different blocks, of which the paravertebral nerve block is one such block that has been effective. We present a case of a patient undergoing excision of a scapular osteochondroma who received a single-shot paravertebral nerve block after surgery with an effective analgesia.

Purpose: To compare the impact of erector spinae plane block (ESPB) and paravertebral block (PVB) on the quality of postoperative recovery (QoR) of patients following laparoscopic sleeve gastrectomy (LSG). Methods: A total of 110 patients who underwent elective LSG under general anesthesia were randomly assigned to receive either ultrasound-guided bilateral ESPB or PVB at T8 levels. Before anesthesia induction, 40 mL of 0.33% ropivacaine was administered. The primary outcome was the QoR-15 score at 24 hours postoperatively. Results: At 24 hours postoperatively, the QoR-15 score was comparable between the ESPB and PVB groups (131 (112–140) vs. 124 (111–142.5), P = 0.525). Consistently, there was no significant difference in QoR-15 scores at 48 hours postoperatively, numerical rating scale (NRS) pain scores at any postoperative time points, time to first ambulation, time to first anal exhaust, postoperative cumulative oxycodone consumption, and incidence of postoperative nausea and vomiting (PONV) between the two groups (all P > 0.05). No nerve block-related complications were observed in either group. Conclusion: In patients undergoing LSG, preoperative bilateral ultrasound-guided ESPB yields comparable postoperative recovery to preoperative bilateral ultrasound-guided PVB. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Serratus anterior plane block (SAPB) and paravertebral block (PVB) are well known to reduce pain levels after video-assisted thoracoscopic surgery (VATS). However, the relative efficacies of each block and a combination of the 2 have not been fully characterized. The objective of the present study was to assess the efficacy of PVB alone, SAPB alone and the combination of PVB and SAPB with regard to the occurrence and intensity of pain after VATS. METHODS We conducted the THORACOSOPIC single-centre, double-blind, randomized trial in adult patients due to undergo elective VATS lung resection. The participants were randomized to PVB only, SAPB only and PVB + SAPB groups. The primary end-point was pain on coughing on admission to the postanaesthesia care unit. The secondary end-points were postoperative pain at rest and on coughing at other time points and the cumulative opioid consumption. Pain was scored on a visual analogue scale. RESULTS One-hundred and fifty-six patients (52 in each group) were included. On admission to the postanaesthesia care unit, the 3 groups did not differ significantly with regard to the pain on coughing: the visual analogue scale score was 3 (0–6), 4 (0–8) and 2 (0–6) in the PVB, SAPB and PVB + SAPB groups, respectively (P  =   0.204). During postoperative care, the overall pain score was significantly lower in the SABP + PVP group at rest and on cough. CONCLUSIONS The combination of SABP + PVB could be beneficial for pain management in VATS in comparison to SABP or PVB alone. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the efficacy of epidural catheter and paravertebral block methods for the management of postoperative pain in patients undergoing thoracotomy and pneumonectomy and to develop clinical routines for optimal pain control. Methods: Hemodynamic data, arterial blood gas values, VAS scores (at ICU admission and postoperative 8, 16, and 24 h), total amount of rescue analgesics for 24 h, and mortality rates of patients undergoing pneumonectomy treated with preoperative thoracic epidural analgesia (TEA) and paravertebral block were compared. Results: Patients’ pain scores upon admission to the ICU and 8, 16, and 24 h postoperatively and the total amount of rescue analgesia administered during the study period were compared. VAS scores 8 and 16 h postoperatively were statistically similar between the groups. Additionally, postoperative ICU admission and 24-h VAS follow-up were significantly lower in the TEA group (p<0.05). The mean total dose (mg) of additional morphine at 24 h in PVB group was found to be statistically significantly higher than that in the TEA group (p=0.0001). Conclusion: The data of 2,422 operations were analyzed, and 34 patients were included in this study. No statistically significant difference was observed between the groups in terms of mortality. In this study, we observed that postthoracotomy pain can be managed by paravertebral block with preoperative bolus bupivacaine. This study confirmed that paravertebral block is an effective method for achieving analgesia during pneumectomy, as recommended by the PROSPECT guidelines. [ABSTRACT FROM AUTHOR]

Abstract Introduction Zoster-associated pain (ZAP) treatment and management is still inadequate. Repeated intervention protocol is often applied to manage ZAP. This study aimed to retrospectively investigate the effect of repeated applications of pulsed radiofrequency therapy on controlling acute/subacute ZAP. Methods From March 2019 to December 2021, 150 patients with acute/subacute ZAP who underwent repeated application of pulsed radiofrequency treatment (R-PRF) and pulsed radiofrequency combined paravertebral block interventions (PRF + PVB) in the Pain Department of the affiliated Hospital of Jiaxing University were enrolled. Patients were grouped by intervention protocol and received at least 12 months of follow-up assessments using the Numerical Rating Scale score (NRSs), Pittsburg Sleep Quality Index (PSQI), Simple McGill Pain Questionnaire-2 score (SF-MPQ-2s), and follow-up interventions. Results Both groups experienced a reduction in the incidence of clinically meaningful ZAP after the intervention therapy. In the R-PRF group, there were 36 cases of clinically meaningful ZAP within the first month post-treatment, while the PRF + PVB group had 38 cases. The incidence of clinically meaningful ZAP, as determined by multivariable generalized estimating equations, was 42.86% in the R-PRF group and 57.58% in the PRF + PVB group during the first month of follow-up. There was a significant difference in the incidence of clinically meaningful ZAP between the two groups after 1 month of treatment (adjusted odds ratio: 0.40; 95% confidence interval: 0.18–0.91; p = 0.03). Conclusions Both R-PRF and PRF + PVB treatments effectively relieve pain in patients with acute/subacute ZAP. However, R-PRF may have superior efficacy compared to PRF + PVB in reducing the incidence of clinically meaningful ZAP 1 month after treatment.

Background: Pain associated with traumatic multiple fracture ribs is usually severe, difficult to control, frequently alters pulmonary mechanics, and may even limit movement ability. Thoracic epidural and paravertebral blocks (PVB) have traditionally been employed but they are technically complex, are associated with adverse effects and are often not feasible in the presence of conditions such as coagulopathy, hemo-dynamic instability and vertebral fractures. ESPB is a simple block in terms of easy identification of landmarks with ultrasound and safe block with no neurovascular structures in the ESP. Hence the current study was undertaken to assess clinical utility of this block (ESPB) in comparison with paravertebral blocks (PVB) for pain relief in multiple rib fractures. Methodology: A prospective, randomized, double-blinded study was conducted in 100 adult patients with traumatic multiple rib fractures, during April 2020 to February 2023 after obtaining institutional ethical committee approval. ESPB and PBV was performed under ultrasound guidance. Haemodynamic changes, opioid consumption, time to recue analgesia and VAS scores in both the groups were recorded. Statistical analysis done using independent sample T test when data was normally distributed and Mann whitney U test for skewed distribution with outliers with P<0.05 as statistically significant. SPSS version 20 was the statistical software used. Results: Mean of HR and MAP showed no significant difference in both the groups. Mean and SD of fentanyl consumption in patients of group PVB (176.87± 27.5 microgram) was more which was statistically significant when compared to group ESPB (134.9± 35.8 microgram). VAS static and dynamic showed no significant difference in both the groups when measured periodically in the first 48 hours. Conclusions: In conclusion, ESPB and PVB blocks in multiple rib fractures are effective methods for pain relief with similar haemodynamic effects. ESPB has the advantage of significant decrease in fentanyl consumption and increased time to rescue analgesia compared to PVB. [ABSTRACT FROM AUTHOR]

Introduction: Zoster-associated pain (ZAP) treatment and management is still inadequate. Repeated intervention protocol is often applied to manage ZAP. This study aimed to retrospectively investigate the effect of repeated applications of pulsed radiofrequency therapy on controlling acute/subacute ZAP. Methods: From March 2019 to December 2021, 150 patients with acute/subacute ZAP who underwent repeated application of pulsed radiofrequency treatment (R-PRF) and pulsed radiofrequency combined paravertebral block interventions (PRF + PVB) in the Pain Department of the affiliated Hospital of Jiaxing University were enrolled. Patients were grouped by intervention protocol and received at least 12 months of follow-up assessments using the Numerical Rating Scale score (NRSs), Pittsburg Sleep Quality Index (PSQI), Simple McGill Pain Questionnaire-2 score (SF-MPQ-2s), and follow-up interventions. Results: Both groups experienced a reduction in the incidence of clinically meaningful ZAP after the intervention therapy. In the R-PRF group, there were 36 cases of clinically meaningful ZAP within the first month post-treatment, while the PRF + PVB group had 38 cases. The incidence of clinically meaningful ZAP, as determined by multivariable generalized estimating equations, was 42.86% in the R-PRF group and 57.58% in the PRF + PVB group during the first month of follow-up. There was a significant difference in the incidence of clinically meaningful ZAP between the two groups after 1 month of treatment (adjusted odds ratio: 0.40; 95% confidence interval: 0.18–0.91; p = 0.03). Conclusions: Both R-PRF and PRF + PVB treatments effectively relieve pain in patients with acute/subacute ZAP. However, R-PRF may have superior efficacy compared to PRF + PVB in reducing the incidence of clinically meaningful ZAP 1 month after treatment. [ABSTRACT FROM AUTHOR]

Background: Pain management plays an essential role in postoperative recovery after lung surgeries. The Erector Spinae Plane Block (ESPB) is a widely used regional anaesthesia technique; however, few clinical trials have compared this block to active control in thoracic surgeries. This study evaluated the non‐inferiority of the analgesia provided by ESPB when compared to paravertebral block (PVB) in lung surgeries. Methods: Randomised, active‐controlled, blinded for patients and assessors, non‐inferiority trial. Patients who underwent unilateral lung surgeries were divided into two groups according to the regional anaesthesia technique—continuous ESPB or PVB at the T5 level. The primary outcome was to assess pain using a numerical rating scale (NRS) with a test of the interaction of three measures over 24 h postoperatively. An NRS score ≥ 7 was considered analgesia failure, and the prespecified non‐inferiority margin was 10%. Results: In the interim analysis that terminated this study, 120 participants were enrolled. ESPB patients reported higher mean NRS general values over 24 h, 4.6 ± 3.2 in the ESPB group versus 3.9 ± 2.9 in the PVB group, with a difference of −0.67 (−15.2%) and 95%CI: −1.29 to −0.05 (p =.02), demonstrating not non‐inferiority. In addition, the ESPB group presented higher NRS failure of analgesia over 24 h (p <.01) and required more postoperative opioids (p =.01 over 24 h). There was no difference in patient satisfaction between groups. Conclusion: This trial demonstrated that a continuous erector spinae plane block was not non‐inferior to a continuous paravertebral block for analgesia after lung surgery but resulted in higher levels of postoperative pain and opioid consumption. [ABSTRACT FROM AUTHOR]

Background and Aims: Paravertebral block (PVB) is the regional anaesthesia of choice for percutaneous nephrolithotomy (PCNL). Erector spinae plane block (ESPB) is also effective for the same.This study aims to compare the analgesic efficacy and ease of performing PVB or ESPB for PCNL surgery. Methods: This study was conducted in 60 patients undergoing PCNL, who were randomised to Group P (n = 30; received ultrasound-guided [USG] PVB) and Group E (n = 30; received USG ESPB) after general anaesthesia. Blocks were administered at T10 level on the side of the surgery using 20 ml of 0.25% bupivacaine. The trachea was extubated at the end of surgery. The primary outcome was analgesia duration, and secondary outcomes were postoperative pain scores, analgesic consumption, ease of block performance, time taken to perform the block and complications between the two groups. Continuous variables were compared using an independent sample t-test, and categorical variables were analysed using Pearson's Chi-square test. Results: Demographic variables were comparable in both groups. The mean (standard deviation [SD]) time of first rescue analgesia in Group P and Group E were 16.6 (20.4)(95% confidence interval [CI]: 9.02–20.32) h and 16.3 (21.8) (95% CI: 8.17–24.51) h, respectively (P = 0.95). The postoperative pain scores and number of doses of analgesics used were comparable between the groups (P > 0.05). The time taken to perform PVB was much longer compared to the time taken to perform ESPB (P = 0.01). Conclusion: USG PVB and ESPB were equally effective for postoperative analgesia for PCNL surgery. [ABSTRACT FROM AUTHOR]

Background: Regional analgesia provides adequate management of pain during mastectomies and early postoperative period. The erector spinae plane block (ESPB) is a promising regional technique. This study compared the efficacy of ESPB versus paravertebral block (PVB) catheters for pain management in modified radical mastectomy (MRM). Methods: This randomized, double-blind, non-inferiority study recruited 70 adult female cases planned for MRM. The patients were equally randomized into two groups: group ESPB and group PVB. The blocks were performed before general anesthesia induction with 20 ml bupivacaine 0.25%, then 0.1 ml/kg/hr continuous infusion through a catheter. Results: The duration of block performance was significantly lower in the group ESPB than in the group PVB (P < 0.001). The total morphine consumption in 48 h postoperative was 1.54 ± 3.74 mg in group ESPB and 1.68 ± 3.48 mg in group PVB (P = 0.878). Patients required fentanyl and postoperative morphine in the 1st 48 h, time to 1st request analgesia insignificantly differed between groups. Intraoperative and postoperative heart rate, mean arterial pressure and oxygen saturation, and visual analog scale at rest and movement insignificantly differed between groups. Postoperative pneumothorax occurred in one case in group PVB and did not occur in group ESPB. Conclusions: In MRM, analgesic efficacy of preoperative ultrasound-guided ESPB and PVB is comparable, and ESPB is an easier technique and more safer to perform when compared to PVB. [ABSTRACT FROM AUTHOR]

Purpose To compare the impact of erector spinae plane block (ESPB) and paravertebral block (PVB) on the quality of postoperative recovery (QoR) of patients following laparoscopic sleeve gastrectomy (LSG). Methods A total of 110 patients who underwent elective LSG under general anesthesia were randomly assigned to receive either ultrasound-guided bilateral ESPB or PVB at T8 levels. Before anesthesia induction, 40 mL of 0.33% ropivacaine was administered. The primary outcome was the QoR-15 score at 24 hours postoperatively. Results At 24 hours postoperatively, the QoR-15 score was comparable between the ESPB and PVB groups (131 (112–140) vs. 124 (111–142.5), P = 0.525). Consistently, there was no significant difference in QoR-15 scores at 48 hours postoperatively, numerical rating scale (NRS) pain scores at any postoperative time points, time to first ambulation, time to first anal exhaust, postoperative cumulative oxycodone consumption, and incidence of postoperative nausea and vomiting (PONV) between the two groups (all P > 0.05). No nerve block-related complications were observed in either group. Conclusion In patients undergoing LSG, preoperative bilateral ultrasound-guided ESPB yields comparable postoperative recovery to preoperative bilateral ultrasound-guided PVB.

Abstract Background Thoracotomy is considered one of the most painful surgical procedures and can cause debilitating chronic post-surgical pain lasting months or years postoperatively. Aggressive management of acute pain resulting from thoracotomy may reduce the likelihood of developing chronic pain. This trial compares the two most commonly used modes of acute analgesia provision at the time of thoracotomy (thoracic epidural blockade (TEB) and paravertebral blockade (PVB)) in terms of their clinical and cost-effectiveness in preventing chronic post-thoracotomy pain. Methods TOPIC 2 is a multi-centre, open-label, parallel group, superiority, randomised controlled trial, with an internal pilot investigating the use of TEB and PVB in 1026 adult (≥ 18 years old) patients undergoing thoracotomy in up to 20 thoracic centres throughout the UK. Patients (N = 1026) will be randomised in a 1:1 ratio to receive either TEB or PVB. During the first year, the trial will include an integrated QuinteT (Qualitative Research Integrated into Trials) Recruitment Intervention (QRI) with the aim of optimising recruitment and informed consent. The primary outcome is the incidence of chronic post-surgical pain at 6 months post-randomisation defined as ‘worst chest pain over the last week’ equating to a visual analogue score greater than or equal to 40 mm indicating at least a moderate level of pain. Secondary outcomes include acute pain, complications of regional analgesia and surgery, health-related quality of life, mortality and a health economic analysis. Discussion Both TEB and PVB have been demonstrated to be effective in the prevention of acute pain following thoracotomy and nationally practice is divided. Identification of which mode of analgesia is both clinically and cost-effective in preventing chronic post-thoracotomy pain could ameliorate the debilitating effects of chronic pain, improving health-related quality of life, facilitating return to work and caring responsibilities and resulting in a cost saving to the NHS. Trial registration NCT03677856 [ClinicalTrials.gov] registered September 19, 2018. https://clinicaltrials.gov/ct2/show/NCT03677856 . First patient recruited 8 January 2019.

Abstract Introduction The efficacy of erector spinae plane block versus paravertebral block for thoracoscopic surgery remains controversial. We conduct a systematic review and meta-analysis to explore the impact of erector spinae plane block versus paravertebral block on thoracoscopic surgery. Methods We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through March 2022 for randomized controlled trials (RCTs) assessing the effect of erector spinae plane block versus paravertebral block on thoracoscopic surgery. This meta-analysis is performed using the random-effect model. Results Seven RCTs are included in the meta-analysis. Overall, compared with erector spinae plane block for thoracoscopic surgery, paravertebral block results in significantly reduced pain scores at 12 h (SMD = 1.12; 95% CI 0.42 to 1.81; P = 0.002) and postoperative anesthesia consumption (SMD = 1.27; 95% CI 0.30 to 2.23; P = 0.01), but these two groups have similar pain scores at 1-2 h (SMD = 1.01; 95% CI − 0.13 to 2.15; P 0.08) and 4–6 h (SMD = 0.33; 95% CI − 0.16 to 0.81; P = 0.19), as well as incidence of nausea and vomiting (OR 0.93; 95% CI 0.38 to 2.29; P = 0.88). Conclusions Paravertebral block may be better for the pain relief after thoracoscopic surgery than erector spinae plane block.

Abstract Background To investigate the effects of body mass index (BMI) on intensity postoperative pain in patients who underwent thoracic paravertebral block (TPVB) for postoperative analgesia after video-assissted thoracoscopic surgery (VATS). Methods Patients aged 18–80 years, ASA I-III, and BMI 18–40 kg/m2 who underwent elective VATS were included in the study. The patients were divided into 3 groups according to their BMI levels. TPVB was performed under ultrasound-guidance at the fifth thoracic vertebrae, and 30 ml of 0.25% bupivacaine was injected. The patient-controlled analgesia (PCA) was performed by using morphine and multimodal analgesia was performed. As a rescue analgesic agent, 0.5 mg/kg tramadol was given to patients intravenously when a score of visual analog scale (VAS) at rest was ≥ 4. The primary outcome was determined as VAS scores at rest and cough. Secondary outcomes were determined as postoperative morphine consumption, additional analgesic requirement, and side effects. Results The post-hoc test revealed that the VAS resting scores at the 4th hour (p: 0.007), 12th hour (p: 0.014), and 48th hour (p: 0.002) were statistically significantly lower in Group I compared to Group II. Additionally, VAS resting scores were also statistically significantly lower in Group I compared to Group III at all time points (p

Abstract Surgery to repair pectus excavatum (PE) is often associated with severe postoperative pain, which can impact the length of hospital stay (LOS). While thoracic epidural analgesia (TEA) has traditionally been used for pain management in PE, its placement can sometimes result in severe neurological complications. Recently, paravertebral block (PVB) and erector spinae plane block (ESPB) have been recommended for many other chest and abdominal surgeries. However, due to the more severe and prolonged pain associated with PE repair, it is still unclear whether continuous administration of these blocks is as effective as TEA. Therefore, we conducted this systematic review and meta-analysis to demonstrate the equivalence of continuous PVB and ESPB to TEA.

Abstract Background The intercostobrachial nerve blockade is required, in addition to brachial plexus block, to anesthetize the entire upper arm. No studies have described the use of erector spinae plane (ESP) block for an intercostobrachial nerve block. Case presentation A 72-year-old man was scheduled to undergo left brachial vein transposition-arteriovenous fistula creation for hemodialysis access. An ultrasound-guided infraclavicular brachial plexus block was performed using a mixture of 0.5% levobupivacaine (12.5 ml) and 2% lidocaine (12.5 ml). An ESP block was implemented using 10 ml of the same local anesthetic at the T2 level. A pinprick test showed that the entire upper arm and lateral aspect of the left upper chest wall were anesthetized 20 min after the blocks. Surgery was successfully performed without the need for general anesthesia. Conclusions In the present case, an ESP block performed at the T2 level provided sensory loss of the area innervated by the intercostobrachial nerve.

Background: Thoracotomy is considered one of the most painful surgical procedures and can cause debilitating chronic post-surgical pain lasting months or years postoperatively. Aggressive management of acute pain resulting from thoracotomy may reduce the likelihood of developing chronic pain. This trial compares the two most commonly used modes of acute analgesia provision at the time of thoracotomy (thoracic epidural blockade (TEB) and paravertebral blockade (PVB)) in terms of their clinical and cost-effectiveness in preventing chronic post-thoracotomy pain. Methods: TOPIC 2 is a multi-centre, open-label, parallel group, superiority, randomised controlled trial, with an internal pilot investigating the use of TEB and PVB in 1026 adult (≥ 18 years old) patients undergoing thoracotomy in up to 20 thoracic centres throughout the UK. Patients (N = 1026) will be randomised in a 1:1 ratio to receive either TEB or PVB. During the first year, the trial will include an integrated QuinteT (Qualitative Research Integrated into Trials) Recruitment Intervention (QRI) with the aim of optimising recruitment and informed consent. The primary outcome is the incidence of chronic post-surgical pain at 6 months post-randomisation defined as 'worst chest pain over the last week' equating to a visual analogue score greater than or equal to 40 mm indicating at least a moderate level of pain. Secondary outcomes include acute pain, complications of regional analgesia and surgery, health-related quality of life, mortality and a health economic analysis. Discussion: Both TEB and PVB have been demonstrated to be effective in the prevention of acute pain following thoracotomy and nationally practice is divided. Identification of which mode of analgesia is both clinically and cost-effective in preventing chronic post-thoracotomy pain could ameliorate the debilitating effects of chronic pain, improving health-related quality of life, facilitating return to work and caring responsibilities and resulting in a cost saving to the NHS. Trial registration: NCT03677856 [ClinicalTrials.gov] registered September 19, 2018. https://clinicaltrials.gov/ct2/show/NCT03677856. First patient recruited 8 January 2019. [ABSTRACT FROM AUTHOR]

Pain after thoracotomy is one of the most severe pains after surgery. Respiratory muscle splinting due to poor control of post-operative pain may lead to respiratory complications and delayed recovery. In studies addition of dexmedetomidine or fentanyl to local anaesthetics showed enhanced quality of anaesthesia, reduced post-operative analgesic requirement and improved quality and duration of sensory neural blockade. But there are very few studies comparing dexmedetomidine and fentanyl as an adjuvant to ropivacaine in paravertebral block for post thoracotomy analgesia. 80 patients scheduled to undergo elective thoracotomy were randomly divided into two groups. Group A patients received infusion of 0.2% ropivacaine + 2µg/ml(microgram/millilitre) fentanyl @ 0.1ml/kg/h(millilitre/kilogram/hour) and Group B patients received infusion of 0.2% ropivacaine + 1µg/ml dexmedetomidine @ 0.1ml/kg/h in continuous paravertebral block. The patients had visual analogue scale(VAS) at rest between 1-3 in fentanyl group and 1-2 in dexmedetomidine group.(p value >0.05) The mean VAS score for the severity of pain at coughing was between 2-3 in fentanyl group and 1-2.5 in dexmedetomidine group and the difference is statistically significant.(p value <0.05) 12 patients in fentanyl group received rescue analgesic compared to 4 patients in dexmedetomidine group.(p value <0.05) Total fentanyl consumption was more in fentanyl group compared to dexmedetomidine group.(p value >0.05) There was no difference in incidence of side effects in both groups.(p value >0.05) Dexmedetomidine as an adjuvant to ropivacaine provided better post-operative analgesia during coughing and significantly reduced the requirement of rescue analgesic in comparison to fentanyl group without any significant adverse effects. [ABSTRACT FROM AUTHOR]

Purpose of Review: Rib fractures are a common traumatic injury that has been traditionally treated with systemic opioids and non-opioid analgesics. Due to the adverse effects of opioid analgesics, regional anesthesia techniques have become an increasingly promising alternative. This review article aims to explore the efficacy, safety, and constraints of medical management and regional anesthesia techniques in alleviating pain related to rib fractures. Recent Findings: Recently, opioid analgesia, thoracic epidural analgesia (TEA), and paravertebral block (PVB) have been favored options in the pain management of rib fractures. TEA has positive analgesic effects, and many studies vouch for its efficacy; however, it is contraindicated for many patients. PVB is a viable alternative to those with contraindications to TEA and exhibits promising outcomes compared to other regional anesthesia techniques; however, a failure rate of up to 10% and adverse complications challenge its administration in trauma settings. Serratus anterior plane blocks (SAPB) and erector spinae blocks (ESPB) serve as practical alternatives to TEA or PVB with lower incidences of adverse effects while exhibiting similar levels of analgesia. ESPB can be performed by trained emergency physicians, making it a feasible procedure to perform that is low-risk and efficient in pain management. Compared to the other techniques, intercostal nerve block (ICNB) had less analgesic impact and required concurrent intravenous medication to achieve comparable outcomes to the other blocks. Summary: The regional anesthesia techniques showed great success in improving pain scores and expediting recovery in many patients. However, choosing the optimal technique may not be so clear and will depend on the patient's case and the team's preferences. The peripheral nerve blocks have impressive potential in the future and may very well surpass neuraxial techniques; however, further research is needed to prove their efficacy and weaknesses. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether paravertebral block reduces postoperative delirium (POD)/delayed neurocognitive recovery (DNR) in adults after major surgery with general anesthesia. Methods: For this systematic review and meta-analysis, we searched online databases PubMed, EMBASE, CENTRAL, and Web of Science till March 19th, 2023 to examine studies which use paravertebral block (PVB) for perioperative neurocognitive disorder. Primary and secondary outcomes were identified for the incidence of perioperative neurocognitive disorder. We did not restrict the follow-up duration of the included studies. Statistical analysis was performed to calculate mean difference (MD), Odd ratios (OR) and CI between RCTs. The quality of the evidence was assessed with the Cochrane risk of bias tool. The registration number of the study in PROSPERO is CRD42023409502. PROSPERO is an international database of prospectively registered systematic reviews. Registration provides transparency in the review process and it helps counter publication bias. Results: Total 1,225 patients from 9 RCTs were analyzed. The incidence of POD [Odds Ratio (OR) = 0.48, 95% CI 0.32, 0.72; p = 0.0004; I 2 = 0%] and DNR [OR = 0.32, 95% CI 0.13, 0.80; p = 0.01; I 2 = 0%] were significantly reduced in PVB group. The analysis showed no significant differences in postoperative MMSE scores [MD = 0.50, 95% CI -2.14, 3.15; p = 0.71; I 2 = 98%]. Paravertebral block analgesia reduces pain scores and/or opioid use after surgery. Additionally, blood pressure was significantly lower in the PVB group, intraoperatively [MD =-15.50, 95% CI -20.71, -10.28; p < 0.001; I 2 = 12%] and postoperatively [MD =-5.34, 95% CI -10.65, -0.03 p = 0.05; I 2 = 36%]. Finally, PVB group had significantly shorter hospital stays [MD =-0.86, 95% CI -1.13, -0.59; p < 0.001; I 2 = 0%]. Conclusion: Paravertebral block analgesia may prevent perioperative POD/DNR in patients undergoing major surgery. Further research with large sample sizes is required to confirm its effectiveness. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Paravertebral block is a regional technique involving peripheral nerve stimulator guided injection of local anaesthetic 0.5% bupivacaine (isobaric) at T10 level and L1 level immediately lateral to vertebral column, into the space where spinal cord emerges from the intervertebral foramina and bifurcates into dorsal and ventral rami. This technique provides unilateral motor, sympathetic and prolonged sensory blockade. Spinal anaesthesia for inguinal hernioplasty is widely used which provides intense sensory and motor blockade. It suppresses the stress response to surgical intervention, decreases morbidity in high risk patients and enabling maintenance of analgesia in postoperative period, cardiovascular system specific adverse events such as arterial vasodilation. MATERIAL AND METHODS: This was a prospective, randomized, single blind, comparative study. Adult patients belonging to ASA Grade I and II between ages 18 to 65 years of both sexes undergoing elective unilateral inguinal hernia repair were enrolled in the study. Total 60 subjects were recruited & divided into two groups i.e. 30 subjects in each group. Group P- Peripheral nerve stimulator guided paravertebral block in unilateral inguinal hernia repair using 0.5% Bupivacaine (Isobaric). Group S-Spinal anaesthesia in unilateral inguinal hernia repair using 0.5% Bupivacaine (hyperbaric). RESULTS: In our study we found that mean time of onset of sensory block was significantly longer in Group P (5.80 ± 1.21min) as compared to Group S (3.00 ±00 min). The mean time to achieve maximum sensory level was longer in Group P (16.33±2.01min) as compared to Group S (4.00±0.00min). The mean time for onset of motor block in Group P(9.73±1.01min) was significantly longer than Group S (5.00±00 min). The mean duration of motor block was longer in Group S (210.53±14.0min) compared to Group P (196.67±16.31min). The mean time to achieve maximum motor level was longer in Group P (19.73±2.08min) compared to Group S (5.00±0.00min). Mean duration of surgery in Group P (82.33±10.40min) and in Group S (84.17±10.99min). CONCLUSION: After comparison of Peripheral nerve stimulator guided paravertebral block with spinal anaesthesia in unilateral inguinal hernia repair following conclusions were drawn: Two segment paravertebral block provides an excellent anaesthesia with unilateral motor, sympathetic and prolonged sensory blockade. Paravertebral block provides prolonged post-operative analgesia, better haemodynamic control and lesser incidence of side effects like urinary retention. [ABSTRACT FROM AUTHOR]

Thoracic paravertebral block (TPVB) is a common method of inducing perioperative analgesia in thoracic and abdominal surgery. Identifying anatomical structures in ultrasound images is very important especially for inexperienced anesthesiologists who are unfamiliar with the anatomy. Therefore, our aim was to develop an artificial neural network (ANN) to automatically identify (in real-time) anatomical structures in ultrasound images of TPVB. This study is a retrospective study using ultrasound scans (both video and standard still images) that we acquired. We marked the contours of the paravertebral space (PVS), lung, and bone in the TPVB ultrasound image. Based on the labeled ultrasound images, we used the U-net framework to train and create an ANN that enabled real-time identification of important anatomical structures in ultrasound images. A total of 742 ultrasound images were acquired and labeled in this study. In this ANN, the Intersection over Union (IoU) and Dice similarity coefficient (DSC or Dice coefficient) of the paravertebral space (PVS) were 0.75 and 0.86, respectively, the IoU and DSC of the lung were 0.85 and 0.92, respectively, and the IoU and DSC of the bone were 0.69 and 0.83, respectively. The accuracies of the PVS, lung, and bone were 91.7%, 95.4%, and 74.3%, respectively. For tenfold cross validation, the median interquartile range for PVS IoU and DSC was 0.773 and 0.87, respectively. There was no significant difference in the scores for the PVS, lung, and bone between the two anesthesiologists. We developed an ANN for the real-time automatic identification of thoracic paravertebral anatomy. The performance of the ANN was highly satisfactory. We conclude that AI has good prospects for use in TPVB. Clinical registration number: ChiCTR2200058470 (URL: http://www.chictr.org.cn/showproj.aspx?proj=152839; registration date: 2022-04-09). [ABSTRACT FROM AUTHOR]

Background: To investigate the effects of body mass index (BMI) on intensity postoperative pain in patients who underwent thoracic paravertebral block (TPVB) for postoperative analgesia after video-assissted thoracoscopic surgery (VATS). Methods: Patients aged 18–80 years, ASA I-III, and BMI 18–40 kg/m2 who underwent elective VATS were included in the study. The patients were divided into 3 groups according to their BMI levels. TPVB was performed under ultrasound-guidance at the fifth thoracic vertebrae, and 30 ml of 0.25% bupivacaine was injected. The patient-controlled analgesia (PCA) was performed by using morphine and multimodal analgesia was performed. As a rescue analgesic agent, 0.5 mg/kg tramadol was given to patients intravenously when a score of visual analog scale (VAS) at rest was ≥ 4. The primary outcome was determined as VAS scores at rest and cough. Secondary outcomes were determined as postoperative morphine consumption, additional analgesic requirement, and side effects. Results: The post-hoc test revealed that the VAS resting scores at the 4th hour (p: 0.007), 12th hour (p: 0.014), and 48th hour (p: 0.002) were statistically significantly lower in Group I compared to Group II. Additionally, VAS resting scores were also statistically significantly lower in Group I compared to Group III at all time points (p < 0.05). Similarly, the post-hoc test indicated that the VAS coughing scores at the 4th hour (p: 0.023), 12th hour (p: 0.011), and 48th hour (p: 0.019) were statistically significantly lower in Group I compared to Group II. Moreover, VAS coughing scores were statistically significantly lower in Group I compared to Group III at all time points (p < 0.001). Furthermore, there were statistically significant differences in terms of additional analgesic use between the groups (p: 0.001). Additionally, there was a statistically significant difference in terms of morphine consumption via PCA and morphine milligram equivalent consumption between the groups (p < 0.001). Conclusions: Higher postoperative VAS scores with TPVB applied in obese patients and the consequent increase in additional analgesics and complications require more specific postoperative management in this patient group. [ABSTRACT FROM AUTHOR]

The study was conducted in the Thoracoabdominal Department of the N.V. Sklifosovsky Research Institute for Emergency Medicine to explore the role of paravertebral block in the treatment of blunt chest trauma. The study included 715 patients with isolated chest trauma hospitalized between January 1, 2020 and August 2021. 55 patients received analgesic therapy in the form of paravertebral block. The comparison group included 660 patients who did not undergo paravertebral block, in their case pain relief was provided by systemic administration of analgesics. The compared groups did not differ significantly in sex and age composition. There were also no differences in the frequency of chronic diseases and interpleural complications. There were no significant complications during the block. The comparison revealed a significant decrease in the incidence of pleurisy and a shorter length of stay in hospital. Paravertebral block is an effective and safe method of pain management for patients with blunt chest trauma. The use of this technique reduces the incidence of post-traumatic pleurisy and duration of hospitalization.

Objective: To compare the post-operative analgesic efficacy and adverse effect profile of ultrasound-guided paravertebral plane block with intravenous Nalbuphine in patients with breast cancer planned for modified radical mastectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Anesthesia Department Combined Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2022. Methodology: A total of 106 patients diagnosed with breast cancer Stage I and II requiring modified radical mastectomy were included. Comparison of the post-operative analgesic efficacy and adverse effect profile of ultrasound-guided paravertebral plane block and intravenous Nalbuphine were noted. Results: One hundred six patients were included in the study, and divided into the Nalbuphine Group (n=53) and the Paravertebral Block (PVB) Group (n=53). The per-operative Nalbuphine requirement was significantly reduced in the PVBGroup, 2.28±0.37 mg versus 5.30±0.24 mg in the Nalbuphine-Group (p

Surgery to repair pectus excavatum (PE) is often associated with severe postoperative pain, which can impact the length of hospital stay (LOS). While thoracic epidural analgesia (TEA) has traditionally been used for pain management in PE, its placement can sometimes result in severe neurological complications. Recently, paravertebral block (PVB) and erector spinae plane block (ESPB) have been recommended for many other chest and abdominal surgeries. However, due to the more severe and prolonged pain associated with PE repair, it is still unclear whether continuous administration of these blocks is as effective as TEA. Therefore, we conducted this systematic review and meta-analysis to demonstrate the equivalence of continuous PVB and ESPB to TEA. [ABSTRACT FROM AUTHOR]

Background: The intercostobrachial nerve blockade is required, in addition to brachial plexus block, to anesthetize the entire upper arm. No studies have described the use of erector spinae plane (ESP) block for an intercostobrachial nerve block. Case presentation: A 72-year-old man was scheduled to undergo left brachial vein transposition-arteriovenous fistula creation for hemodialysis access. An ultrasound-guided infraclavicular brachial plexus block was performed using a mixture of 0.5% levobupivacaine (12.5 ml) and 2% lidocaine (12.5 ml). An ESP block was implemented using 10 ml of the same local anesthetic at the T2 level. A pinprick test showed that the entire upper arm and lateral aspect of the left upper chest wall were anesthetized 20 min after the blocks. Surgery was successfully performed without the need for general anesthesia. Conclusions: In the present case, an ESP block performed at the T2 level provided sensory loss of the area innervated by the intercostobrachial nerve. [ABSTRACT FROM AUTHOR]

Bariatric surgical patients are vulnerable to cardiopulmonary depressant effects of opioids. The enhanced recovery after surgery (ERAS) protocol to improve postoperative morbidity recommends regional anesthesia for postoperative pain management. However, there is limited evidence that peripheral nerve blocks (PNB) have added benefit. Study the effect of PNB on postoperative pain and opioid use following bariatric surgery. Academic medical center, United States. We conducted a cohort study of patients who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. A total of 44 patients received the control ERAS protocol with preoperative oral extended-release morphine sulfate (MS), while 45 patients underwent a PNB with either intrathecal morphine (IM) or oral MS per local ERAS protocol. The PNB group either underwent preoperative bilateral T7 paravertebral (PVT) PNBs (27 patients) with IM or postoperative transversus abdominis plane (TAP) PNBs (18 patients) with oral MS. The primary outcome compared total opioid consumption between the ERAS control group and the PNB group up to 48 hours postoperatively. Secondary outcomes included comparison by block type and postoperative pain scores. PVT or TAP PNB patients had a reduction in mean postoperative oral morphine equivalent (OME) requirements compared with the ERAS protocol cohort at 24 hours (93.9 versus 42.8 mg), P <.0001; at 48 hours (72.6 versus 40.5 mg); and in pain scores at 24 hours (5.64/10 versus 4.46/10), P =.02. OME and pain scores were higher in the SG cohort. Addition of truncal PNB to standard ERAS protocol for bariatric surgical patients reduces postoperative total opioid consumption. 1 Perioperative Truncal Peripheral Nerve Blocks in patients underwent Sleeve Gastrectomy or Roux-en-Y Gastric Bypass resulted in a 54% reduction in oral morphine equivalents (OMEs) requirements perioperatively and up to 24 hours postoperatively 2 Intraoperative and PACU OME requirements showed a 73% reduction in the block group versus the control group 3 There was a 67% reduction in OME requirements in the paravertebral block (PVT) group compared to the transversus Abdominis plane (TAP) group [ABSTRACT FROM AUTHOR]

The primary objectives of the study were to analyse the robotic approach and ultrasound-guided paravertebral block compared to thoracoscopic intercostal nerve block after robotic pulmonary lobectomy on postoperative pain and opioids use. The secondary objectives were to analyse and compare patients' necessity of additional antalgic drugs and patients' performance during respiratory therapy, following robotic surgery and in the two groups. Consecutively, 52 patients undergoing robotic pulmonary lobectomies were treated either with ropivacaine-based intercostal nerve block or paravertebral block from February 2022 to October 2022. When necessary, morphine was administered at day 1. Acetaminophen was administered as an additional antalgic drug on demand up to 3 g per day. Pain was measured 1 h after the end of the surgical procedure and daily through the pain numeric rating scale (NRS). Morphine administration rate and per day and total additional administrations of acetaminophen were recorded. Pain and opioids administration was measured 1 month after the procedure. Data were analysed in the overall population and in the intercostal nerve block group VS paravertebral block group. Overall, 34.6% of the patients required morphine administration and 51.7% of the patients required at least daily acetaminophen administration up to discharge. At 1 month postoperatively, four patients presented with chronic pain and one still was under opioid medication. At intergroup analysis, the paravertebral block group demonstrated lower NRS at fixed time points (p < 0.0001) and lower morphine consumption (45.7%VS11.8%; p = 0.02). Acetaminophen rescue administration at fixed time points was lower in the paravertebral block group (p < 0.0001) and mobility and dynamic pain resulted in better results (p = 0.03; p = 0.04). At 1 month, no differences were found between study groups. Similarly to other minimally invasive techniques, postoperative pain may arise after robotic pulmonary lobectomy. Paravertebral bloc can help to reduce postoperative pain as well as morphine and antalgic drugs administration and improve early mobilization. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Adequate pain management after thoracoscopic surgery is a major issue in the prevention of respiratory complications. The combination of the paravertebral block (PVB) with the serratus anterior plane block (SAPB) may decrease postoperative pain. The objective of this study was to evaluate the impact of the combination of PVB and SAPB on the consumption of morphine and pain after video- or robot-assisted thoracic surgery. METHODS The main objective of this randomized controlled trial was to compare the cumulative postoperative morphine consumption at 24 h between a group having PVB (PVB group) and a group having PVB and SAPB (PV-SAPB group). Postoperative pain at 6 and 24 h and morphine-related complications were also assessed. RESULTS A total of 112 patients were included with 56 in each group. There was no difference in median cumulative morphine consumption at 24 h between the 2 groups (P  = 0.1640). At 6 h, the median postoperative pain was higher in the PVB group compared to the PV-SAPB group (3 [0; 4] vs 2 [0; 3], P  = 0.0231). There were no differences between the 2 groups for pain at 24 h and morphine-related complications. CONCLUSIONS We did not find any difference in morphine consumption between the 2 groups. Our results suggest that the combination of PVB and SAPB for video-assisted thoracic surgery or robot-assisted thoracic surgery is safe effective and reliable and could be an alternative to PVB alone in certain indications. [ABSTRACT FROM AUTHOR]

This study examined the postoperative analgesic efficacy of single-injection pectoral fascial plane (PECS) II blocks compared to paravertebral blocks for elective robotic mitral valve surgery. A single-center retrospective study that reported patient and procedural characteristics, postoperative pain scores, and postoperative opioid use for patients undergoing robotic mitral valve surgery. This investigation was performed at a large quaternary referral center. Adult patients (age ≥18) admitted to the authors' hospital from January 1, 2016, to August 14, 2020, for elective robotic mitral valve repair who received either a paravertebral or PECS II block for postoperative analgesia. Patients received an ultrasound-guided, unilateral paravertebral or PECS II nerve block. One hundred twenty-three patients received a PECS II block, and 190 patients received a paravertebral block during the study period. The primary outcome measures were average postoperative pain scores and cumulative opioid use. Secondary outcomes included hospital and intensive care unit lengths of stay, need for reoperation, need for antiemetics, surgical wound infection, and atrial fibrillation incidence. Patients receiving the PECS II block required significantly fewer opioids in the immediate postoperative period than the paravertebral block group, and had comparable postoperative pain scores. No increase in adverse outcomes was noted for either group. The PECS II block is a safe and highly effective option for regional analgesia for robotic mitral valve surgery, with demonstrated efficacy comparable to the paravertebral block. [ABSTRACT FROM AUTHOR]

Background and Aims: Paravertebral block (PVB) is the regional anaesthesia of choice for percutaneous nephrolithotomy (PCNL). Erector spinae plane block (ESPB) is also effective for the same.This study aims to compare the analgesic efficacy and ease of performing PVB or ESPB for PCNL surgery. Methods: This study was conducted in 60 patients undergoing PCNL, who were randomised to Group P (n = 30; received ultrasound-guided [USG] PVB) and Group E (n = 30; received USG ESPB) after general anaesthesia. Blocks were administered at T10 level on the side of the surgery using 20 ml of 0.25% bupivacaine. The trachea was extubated at the end of surgery. The primary outcome was analgesia duration, and secondary outcomes were postoperative pain scores, analgesic consumption, ease of block performance, time taken to perform the block and complications between the two groups. Continuous variables were compared using an independent sample t-test, and categorical variables were analysed using Pearson's Chi-square test. Results: Demographic variables were comparable in both groups. The mean (standard deviation [SD]) time of first rescue analgesia in Group P and Group E were 16.6 (20.4)(95% confidence interval [CI]: 9.02–20.32) h and 16.3 (21.8) (95% CI: 8.17–24.51) h, respectively (P = 0.95). The postoperative pain scores and number of doses of analgesics used were comparable between the groups (P > 0.05). The time taken to perform PVB was much longer compared to the time taken to perform ESPB (P = 0.01). Conclusion: USG PVB and ESPB were equally effective for postoperative analgesia for PCNL surgery.

Objective:The aim of this research is to examine the effects of the anesthesia method and preoperative characteristics on postoperative results and complications in patients who underwent percutaneous kyphoplasty (PKP).Method:Patients were put into three groups according to the anesthesia methods used: (1) General anesthesia (sedation), (2) Central block (spinal and epidural anesthesia), (3) Peripheral block (erector spina plane block, and paravertebral block). Patients’ pain values, hemodynamic parameters, additional need for sedation, and perioperative and postoperative complications were recorded prospectively together with visual pain scales (VAS).Results:There were 22 individuals in group 1, 20 individuals in group 2, and 24 individuals in group 3. The average paracetamol and tramadol doses, postoperative VAS scores, and additional need for sedation were statistically significantly higher in group 1 (for all p

Background Thoracic paravertebral block (PVB) is an effective regional block for pain control after breast surgery. However, accidentally puncturing adjacent vital structures may cause undesirable complications. Erector spinae plane block (ESPB) has been considered a safer proxy of PVB for beginners. This study aimed to evaluate the analgesic effects of ultrasound-guidance PVB and ESPB after breast surgery. Methods This randomized control trial was conducted in patients who underwent mastectomy. Forty-four females were randomly allocated into PVB group or ESPB group. All patients received a block with 20 ml of 0.5% levobupivacaine before general anesthesia. The primary outcome was the 24-h postoperative morphine requirements. The other outcomes of interest were postoperative pain scores, time to first analgesic request, dermatome of sensory blockade, block-related complications, and opioid adverse events. Results The 24-h morphine requirements were significantly lower in PVB compared to the ESPB group (3.5 ± 3.3 vs. 8.6 ± 3.8 mg, P < 0.001). The overall pain scores were also lower in the PVB group (P < 0.001). Only 14 patients in the PVB group requested additional morphine, whereas all patients in the ESPB group requested it (P = 0.004). The dermatome of sensory blockade was wider in the PVB group (7 vs. 4 levels, P = 0.019). No serious complications occurred in either group. Conclusions Compared to ESPB, PVB provided lower postoperative opioid requirements, lower pain scores, and wider sensory blockade after mastectomy.

Abstract Background Adequate pain control after video-assisted thoracoscopic surgery (VATS) for lung resection is important to improve postoperative mobilisation, recovery, and to prevent pulmonary complications. So far, no consensus exists on optimal postoperative pain management after VATS anatomic lung resection. Thoracic epidural analgesia (TEA) is the reference standard for postoperative pain management following VATS. Although the analgesic effect of TEA is clear, it is associated with patient immobilisation, bladder dysfunction and hypotension which may result in delayed recovery and longer hospitalisation. These disadvantages of TEA initiated the development of unilateral regional techniques for pain management. The most frequently used techniques are continuous paravertebral block (PVB) and single-shot intercostal nerve block (ICNB). We hypothesize that using either PVB or ICNB is non-inferior to TEA regarding postoperative pain and superior regarding quality of recovery (QoR). Signifying faster postoperative mobilisation, reduced morbidity and shorter hospitalisation, these techniques may therefore reduce health care costs and improve patient satisfaction. Methods This multi-centre randomised study is a three-arm clinical trial comparing PVB, ICNB and TEA in a 1:1:1 ratio for pain (non-inferiority) and QoR (superiority) in 450 adult patients undergoing VATS anatomic lung resection. Patients will not be eligible for inclusion in case of contraindications for TEA, PVB or ICNB, chronic opioid use or if the lung surgeon estimates a high probability that the operation will be performed by thoracotomy. Primary outcomes: (1) the proportion of pain scores ≥ 4 as assessed by the numerical rating scale (NRS) measured during postoperative days (POD) 0–2; and (2) the QoR measured with the QoR-15 questionnaire on POD 1 and 2. Secondary outcome measures are cumulative use of opioids and analgesics, postoperative complications, hospitalisation, patient satisfaction and degree of mobility. Discussion The results of this trial will impact international guidelines with respect to perioperative care optimization after anatomic lung resection performed through VATS, and will determine the most cost-effective pain strategy and may reduce variability in postoperative pain management. Trial registration The trial is registered at the Netherlands Trial Register (NTR) on February 1st, 2021 (NL9243). The NTR is no longer available since June 24th, 2022 and therefore a revised protocol has been registered at ClinicalTrials.gov on August 5th, 2022 (NCT05491239). Protocol version: version 3 (date 06-05-2022), ethical approval through an amendment (see ethical proof in the Study protocol proof).

Simple Summary: One of the major issues in thoracic surgery is adequate post-operative pain management. Inadequate management leads to complications, such as atelectasis, pneumonia, respiratory failure, and the development of chronic pain. Paravertebral block (PVB) has now become the first-line locoregional technique for video-assisted thoracic surgery (VATS) or robot-assisted thoracic surgery (RATS). New chest wall blocks, such as the erector spinae plane block (ESPB) have been described in recent years to facilitate analgesia and limit the risk of puncturing adjacent structures (neuroaxial, pleural, or vascular punctures). The ESPB is more superficial than the PVB and some studies suggest that the anesthetic could spread into the thoracic paravertebral space. Therefore, the ESPB may have fewer complications and be more effective than PVB. We hypothesize that the ESPB could decrease post-operative pain compared to PVB block after VATS or RATS for lung cancer. Introduction: The prevention of respiratory complications is a major issue after thoracic surgery for lung cancer, and requires adequate post-operative pain management. The erector spinae plane block (ESPB) may decrease post-operative pain. The objective of this study was to evaluate the impact of ESPB on pain after video or robot-assisted thoracic surgery (VATS or RATS). Methods: The main outcome of this retrospective study with a propensity score analysis (PSA) was to compare the post-operative pain at 24 h at rest and at cough between a group that received ESPB and a group that received paravertebral block (PVB). Post-operative morphine consumption at 24 h and complications were also assessed. Results: One hundred and seven patients were included: 54 in the ESPB group and 53 in the PVB group. The post-operative median pain score at rest and cough was lower in the ESPB group compared to the PVB group at 24 h (respectively, at rest 2 [1; 3.5] vs. 2 [0; 4], p = 0.0181, with PSA; ESPB −0.80 [−1.50; −0.10], p = 0.0255, and at cough (4 [3; 6] vs. 5 [4; 6], p = 0.0261, with PSA; ESPB -1.48 [−2.65; −0.31], p = 0.0135). There were no differences between groups concerning post-operative morphine consumption at 24 h and respiratory complications. Conclusions: Our results suggest that ESPB is associated with less post-operative pain at 24 h than PVB after VATS or RATS for lung cancer. Furthermore, ESPB is an acceptable and safe alternative compared to PVB. [ABSTRACT FROM AUTHOR]