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Introduction: Chronic post-surgical pain (CPSP) remains a prevalent issue following video-assisted thoracic surgery (VATS), despite advancements in surgical techniques. Various regional anesthesia techniques, including thoracic paravertebral block (PVB), intercostal nerve block (ICNB), serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural anesthesia (TEA), have been employed in VATS procedures to mitigate this issue. This study aims to compare the efficacy of these analgesia methods in reducing the incidence of CPSP in VATS patients through a network meta-analysis. Methods: A systematic search was conducted in PubMed, the Cochrane Library, and EMBASE for randomized controlled trials (RCTs) comparing the incidence of CPSP associated with PVB, ICNB, SAPB, ESPB, and TEA. The occurrence of CPSP was evaluated at both 2–3 months and 6 months post-surgery. Results: Six RCTs, involving 652 patients, were included in the analysis of CPSP incidence at 2–3 months, while seven RCTs, involving 715 patients, were included for 6 months analysis. PVB, ICNB, or TEA reduced CPSP incidence compared with control group (without regional anesthesia techniques) at both 2–3 months and 6 months post-surgery. However, SAPB was found less effective in reducing CPSP incidence at 2–3 months post-VATS compared to PVB, ICNB, or TEA. Conclusions: PVB, ICNB, and TEA exhibit significant effects on reducing CPSP incidence following VATS. Conversely, SAPB is not recommended for reducing CPSP incidence post-VATS. Nonetheless, considering the limitation of a small sample size in this network meta-analysis, additional RCTs are necessary to validate these conclusions and enhance the management of CPSP after VATS. [ABSTRACT FROM AUTHOR]

Abstract Introduction Chronic post-surgical pain (CPSP) remains a prevalent issue following video-assisted thoracic surgery (VATS), despite advancements in surgical techniques. Various regional anesthesia techniques, including thoracic paravertebral block (PVB), intercostal nerve block (ICNB), serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural anesthesia (TEA), have been employed in VATS procedures to mitigate this issue. This study aims to compare the efficacy of these analgesia methods in reducing the incidence of CPSP in VATS patients through a network meta-analysis. Methods A systematic search was conducted in PubMed, the Cochrane Library, and EMBASE for randomized controlled trials (RCTs) comparing the incidence of CPSP associated with PVB, ICNB, SAPB, ESPB, and TEA. The occurrence of CPSP was evaluated at both 2–3 months and 6 months post-surgery. Results Six RCTs, involving 652 patients, were included in the analysis of CPSP incidence at 2–3 months, while seven RCTs, involving 715 patients, were included for 6 months analysis. PVB, ICNB, or TEA reduced CPSP incidence compared with control group (without regional anesthesia techniques) at both 2–3 months and 6 months post-surgery. However, SAPB was found less effective in reducing CPSP incidence at 2–3 months post-VATS compared to PVB, ICNB, or TEA. Conclusions PVB, ICNB, and TEA exhibit significant effects on reducing CPSP incidence following VATS. Conversely, SAPB is not recommended for reducing CPSP incidence post-VATS. Nonetheless, considering the limitation of a small sample size in this network meta-analysis, additional RCTs are necessary to validate these conclusions and enhance the management of CPSP after VATS.

Objective This meta-analysis assesses the efficacy and safety of erector spinae block (ESPB) and paravertebral block (PVB) for managing postoperative pain in thoracic and breast surgeries.Design Data from 12 randomized controlled trials (RCTs) published between 2019 and 2022 were included, and selected based on stringent criteria.Setting The RCTs were conducted across various clinical settings, including operating theaters worldwide.Patients The analysis involved 844 patients undergoing thoracic or breast surgery under regional anesthesia, representing diverse health statuses.Interventions Patients received either PVB or ESPB, typically guided by ultrasound, for postoperative pain control.Main Findings PVB demonstrated superior pain management during rest and mobility, requiring fewer additional analgesics than ESPB. Incidences of postoperative nausea and vomiting (PONV) and opioid consumption did not differ significantly between the methods. ESPB showed more effective block placement.Conclusion PVB is preferred for reducing analgesic requirements and managing postoperative pain, especially during rest and activity. ESPB offers advantages in block placement. Surgical type and patient preferences should guide the choice between PVB and ESPB, necessitating further research for optimized clinical application.

Adequate postoperative pain management remains a challenge. We discuss pathophysiology of pain after cardiac surgery and describe in detail multimodal and regional anesthesia, their advantages and disadvantages.

Objective: This meta-analysis assesses the efficacy and safety of erector spinae block (ESPB) and paravertebral block (PVB) for managing postoperative pain in thoracic and breast surgeries., Design: Data from 12 randomized controlled trials (RCTs) published between 2019 and 2022 were included, and selected based on stringent criteria., Setting: The RCTs were conducted across various clinical settings, including operating theaters worldwide., Patients: The analysis involved 844 patients undergoing thoracic or breast surgery under regional anesthesia, representing diverse health statuses., Interventions: Patients received either PVB or ESPB, typically guided by ultrasound, for postoperative pain control., Main Findings: PVB demonstrated superior pain management during rest and mobility, requiring fewer additional analgesics than ESPB. Incidences of postoperative nausea and vomiting (PONV) and opioid consumption did not differ significantly between the methods. ESPB showed more effective block placement., Conclusion: PVB is preferred for reducing analgesic requirements and managing postoperative pain, especially during rest and activity. ESPB offers advantages in block placement. Surgical type and patient preferences should guide the choice between PVB and ESPB, necessitating further research for optimized clinical application.

Objective Ultrasound-guided regional anesthesia with in-plane needle approaches can be challenging due to difficult needle visualization. We hypothesized that an in-plane, multiangle needle guide can help reduce the time it takes novice regional anesthesiologists to perform a simulated ultrasound-guided nerve-targeting procedure and enhance the visualization of the needle. Design Crossover simulation study. Setting Simulation environment at an academic institution. Subjects Volunteer trainees in their postgraduate years 1 and 2. Methods Sixteen subjects were randomized to repeat a single nerve targeting simulation task four times with and four times without a needle guide. End points were time to complete the nerve targeting, needle visualization, number of passes, and needle approximation to the target. Results The needle guide reduced median time to complete the task by 27% (95% confidence interval: 4-44%) and increased the odds of an acceptable needle visualization by 355% (95% confidence interval: 171-737%). A learning benefit for the time outcome was also noted, with multiple attempts regardless of whether the needle guide was used or not. Conclusions A needle guide can help reduce the time needed to complete a simulated nerve targeting procedure and enhance needle visualization for the novice sonographer in a phantom gel simulation. There was no significant reduction in the number of needle passes or in improvement of target approximation noted. [ABSTRACT FROM AUTHOR]

Regional anesthesia plays a key role in the treatment of patients with orthopedic trauma. Trauma-induced pain can be in multiple locations, severe, and can predispose the patient to other morbidities. Additional complications as a result of the overdependence on opioids as a primary pain therapy that can be minimized or avoided with the use of regional anesthesia. Both neuraxial and peripheral regional techniques in patients with orthopedic trauma should be incorporated into the patient care plan and recognized as an essential therapeutic intervention in the overall treatment of this unique patient population., (Copyright © 2014 Elsevier Inc. All rights reserved.)