Evaluation of ultrasound-guided pecto-intercostal block in canine cadavers

Abstract Background Rhomboid intercostal block (RIB) and Rhomboid intercostal block with sub-serratus plane block (RISS) are the two types of plane blocks used for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). This prospective randomized controlled trial was performed to analyze the postoperative analgesic effects of ultrasound-guided RIB block and RISS block after video-assisted thoracoscopic surgery. Methods Ninety patients aged between 18 and 80 years, with American Society of Anesthesiologists physical status Classes I–II and scheduled for elective unilateral VATS were randomly allocated into three groups. In group C, no block intervention was performed. Patients in group RIB received ultrasound-guided RIB with 20-mL 0.375% ropivacaine and those in group RISS received ultrasound-guided RIB and serratus plane block using a total of 40-mL 0.375% ropivacaine. All patients received intravenous sufentanil patient-controlled analgesia upon arrival in the recovery room. Postoperative sufentanil consumption and pain scores were compared among the groups. Results The dosages of sufentanil consumption at 24 h after the surgery in the RIB and RISS groups were significantly lower than that in group C (p < 0.001 and p < 0.001 for all comparisons, respectively), the postoperative Numerical Rating Scale (NRS) scores in the RIB and RISS groups at 0.5, 1, 3, 6, 12, 18, and 24 h after surgery when patients were at rest or active were significantly lower than that in group C (p < 0.05 for all comparisons). The required dosage of sufentanil and time to first postoperative analgesic request in groupRISS were less than those in the group RIB at 24 h after the surgery (p < 0.001 and p < 0.001 for all comparisons, respectively). Similarly, the Numerical Rating Scale scores for group RISS at 12, 18, and 24 h after the surgery when the patients were active were significantly lower than those for group RIB (p < 0.05 for all comparisons). Conclusion Both ultrasound-guided RIB block and RISS block can effectively reduce the demand for sufentanil within 24 h after VATS, and less sufentanil dosage is needed in patient with RISS block. Ultrasound-guided RIB block and RISS block can effectively relieve pain within 24 h after VATS, and RISS block is more effective.

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Comparison of ultrasound‐guided type‐II pectoral nerve block and rhomboid intercostal block for pain management following breast cancer surgery: a randomized, controlled trial

Pain Practice ◽

10.1111/papr.13004 ◽

2021 ◽

Author(s):

Bahadir Ciftci ◽

Mursel Ekinci ◽

Pelin Basim ◽

Erkan Cem Celik ◽

Ismail Cem Tukac ◽

...

Keyword(s):

Breast Cancer ◽

Randomized Controlled Trial ◽

Pain Management ◽

Controlled Trial ◽

Breast Cancer Surgery ◽

Type Ii ◽

Ultrasound Guided ◽

Randomized Controlled ◽

Pectoral Nerve ◽

Intercostal Block

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Ultrasound-guided rhomboid intercostal block effectively manages myofascial pain

Korean Journal of Anesthesiology ◽

10.4097/kja.20211 ◽

2020 ◽

Vol 73 (6) ◽

pp. 564-565 ◽

Cited By ~ 2

Author(s):

Mürsel Ekinci ◽

Bahadir Ciftci ◽

Haci Ahmet Alici ◽

Ali Ahiskalioglu

Keyword(s):

Myofascial Pain ◽

Ultrasound Guided ◽

Intercostal Block

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The Ultrasound-guided Proximal Intercostal Block: Anatomical study and clinical correlation to analgesia for breast surgery

10.21203/rs.2.321/v1 ◽

2019 ◽

Author(s):

Nantthasorn Zinbonyahgoon ◽

Panya Luksanapruksa ◽

Sitha Piyaselakul ◽

Pawinee Pangthipampai ◽

Suphalerk Lohasammakul ◽

...

Keyword(s):

Breast Surgery ◽

Anatomical Study ◽

Opioid Consumption ◽

Intercostal Space ◽

Lateral Spread ◽

Parietal Pleura ◽

Ultrasound Guided ◽

Paravertebral Space ◽

Intercostal Block ◽

Fascial Plane

Abstract Background: The ultrasound-guided proximal intercostal block (PICB) is performed at the proximal intercostal space (ICS) between the internal intercostal membrane (IIM) and the endothoracic fascia/parietal pleura (EFPP) complex. Injectate spread may follow several routes and allow for multilevel trunk analgesia. The goal of this study was to examine the anatomical spread of large-volume PICB injections and its relevance to breast surgery analgesia. Methods: Fifteen two-level PICBs were performed in ten soft-embalmed cadavers. Radiographic contrast mixed with methylene blue was injected at the 2nd(15ml) and 4th(25ml) ICS, respectively. Fluoroscopy and dissection were performed to examine the injectate spread. Additionally, the medical records of 12 patients who had PICB for breast surgery were reviewed for documented dermatomal levels of clinical hypoesthesia. The records of twelve matched patients who had the same operations without PICB were reviewed to compare analgesia and opioid consumption. Results: Median contrast/dye spread was 4(2-8) and 3(2-5) vertebral segments by fluoroscopy and dissection respectively. Dissection revealed injectate spread to the adjacent paravertebral space, T3 (60%) and T5 (27%), and cranio-caudal spread along the endothoracic fascia (80%). Clinically, the median documented area of hypoesthesia was 5(4-7) dermatomes with 100% and 92% of the injections covering adjacent T3 and T5 dermatomes, respectively. The patients with PICB had significantly lower perioperative opioid consumption and trend towards lower pain scores. Conclusions: In this anatomical study, PICB at the 2nd and 4th ICS produced lateral spread along the corresponding intercostal space, medial spread to the adjacent paravertebral/epidural space and cranio-caudal spread along the endothoracic fascial plane. Clinically, combined PICBs at the same levels resulted in consistent segmental chest wall analgesia and reduction in perioperative opioid consumption after breast surgery. The incomplete overlap between paravertebral spread in the anatomical study and area of hypoesthesia in our clinical findings, suggests that additional non-paravertebral routes of injectate distribution, such as the endothoracic fascial plane, may play important clinical role in the multi-level coverage provided by this block technique. Keywords: Nerve block, paravertebral space, intercostal space, intercostal block, breast surgery.

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A prospective, randomized comparison of ultrasonographic visualization of proximal intercostal block vs paravertebral block

BMC Anesthesiology ◽

10.1186/s12871-020-0929-x ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Kamen Vlassakov ◽

Avery Vafai ◽

David Ende ◽

Megan E. Patton ◽

Sonia Kapoor ◽

...

Keyword(s):

Postoperative Pain ◽

Nerve Block ◽

Opioid Consumption ◽

Paravertebral Block ◽

Anatomical Landmarks ◽

Ultrasound Guided ◽

Paravertebral Space ◽

Pain Scores ◽

Performance Times ◽

Intercostal Block

Abstract Background Thoracic paravertebral blockade is an accepted anesthetic and analgesic technique for breast surgery. However, real-time ultrasound visualization of landmarks in the paravertebral space remains challenging. We aimed to compare ultrasound-image quality, performance times, and clinical outcomes between the traditional parasagittal ultrasound-guided paravertebral block and a modified approach, the ultrasound-guided proximal intercostal block. Methods Women with breast cancer undergoing mastectomy (n = 20) were randomized to receive either paravertebral (n = 26) or proximal intercostal blocks (n = 32) under ultrasound-guidance with 2.5 mg/kg ropivacaine prior to surgery. Block ultrasound images before and after needle placement, and anesthetic injection videoclips were saved, and these images and vidoes independently rated by separate novice and expert reviewers for quality of visualization of bony elements, pleura, relevant ligament/membrane, needle, and injectate spread. Block performance times, postoperative pain scores, and opioid consumption were also recorded. Results Composite visualization scores were superior for proximal intercostal compared to paravertebral nerve block, as rated by both expert (p = 0.008) and novice (p = 0.01) reviewers. Notably, both expert and novice rated pleural visualization superior for proximal intercostal nerve block, and expert additionally rated bony landmark and injectate spread visualization as superior for proximal intercostal block. Block performance times, needle depth, opioid consumption and postoperative pain scores were similar between groups. Conclusions Proximal intercostal block yielded superior visualization of key anatomical landmarks, possibly offering technical advantages over traditional paravertebral nerve block. Trial registration ClinicalTrials.gov, NCT02911168. Registred on the 22nd of September 2016.

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