scholarly journals Evaluation of Rhomboid Intercostal Block in Video-Assisted Thoracic Surgery: Comparing Three Concentrations of Ropivacaine

2022 ◽  
Vol 12 ◽  
Author(s):  
Wei Deng ◽  
Chen-Wei Jiang ◽  
Ke-jian Qian ◽  
Fen Liu
Keyword(s):  
Rating Scales ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Psychological Support ◽  
Control Group ◽  
Ultrasound Guided ◽  
Video Assisted ◽  
Physical Comfort ◽  
Double Blinded ◽  
Intercostal Block

Background: Ultrasound-guided rhombic intercostal block (RIB) is a novel regional block that provides analgesia for patients who have received video-assisted thoracoscopic surgery (VATS). The anesthetic characteristics of ultrasound-guided RIB with different concentrations of ropivacaine are not known. This research primarily hypothesizes that ultrasound-guided RIB, given in combination with the same volume of different concentrations of ropivacaine, would improve the whole quality of recovery-40 (QoR-40) among patients with VATS.Approaches: This double-blinded, single-center, prospective, and controlled trial randomized 100 patients undergoing VATS to receive RIB. One hundred patients who have received elective VATS and satisfied inclusion standards were fallen into four groups randomly: control group with no RIB and R0.2%, R0.3%, and R0.4%; they underwent common anesthesia plus the RIB with ropivacaine at 0.2%, 0.3%, and 0.4% in a volume of 30 ml.Outcomes: Groups R0.2%, R0.3%, and R0.4% displayed great diversities in the overall QoR-40 scores and QoR-40 dimensions (in addition to psychological support) by comparing with the control group (Group C) (p < 0.001 for all contrasts). Groups R0.3% and R0.4% displayed great diversities in the overall QoR-40 scores and QoR-40 dimensions (in addition to psychological support) by comparing with the R0.2% group (p < 0.001 for all contrasts). The overall QoR-40 scores and QoR-40 dimensions [physical comfort (p = 0.585)] did not vary greatly between Groups R0.3% and R0.4% (p > 0.05 for all contrasts). Groups R0.2%, R0.3%, and R0.4% showed significant differences in numerical rating scales (NRS) score region under the curve (AUC) at rest and on movement in 48 h when compared with the Group C (p < 0.001 for all contrasts). Groups R0.3% and R0.4% displayed great diversities in NRS score AUC at rest and on movement in 48 h when compared with the R0.2% group (p < 0.001 for all contrasts). The NRS mark AUC at rest and, on movement in 48 h, did not vary greatly between the Group R0.3% and R0.4% (p > 0.05 for all contrasts).Conclusion: In this study it was found that a dose of 0.3% ropivacaine is the best concentration for RIB for patients undergoing VATS. Through growing ropivacaine concentration, the analgesia of the RIB was not improved greatly.Clinicaltrials.gov Registration:https://clinicaltrials.gov/, identifier ChiCTR2100046254.

scholarly journals Evaluation of Rhomboid Intercostal Block in Video-assisted Thoracic Surgery: Comparing three Concentrations of Ropivacaine

2021 ◽  
Author(s):  
Fen Liu ◽  
Wei Deng ◽  
Qing-he Zhou ◽  
Chen-Wei Jiang
Keyword(s):  
Rating Scales ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Psychological Support ◽  
Control Group ◽  
Ultrasound Guided ◽  
Video Assisted ◽  
Physical Comfort ◽  
Double Blinded ◽  
Intercostal Block

Abstract Background: Ultrasound-guided rhombic intercostal block (RIB) is a novel regional block that provides analgesia for patients who have received video-assisted thoracoscopic surgery (VATS). The anesthetic characteristics of ultrasound-guided RIB with different concentrations of ropivacaine are not known. This research primarily hypothesizes that ultrasound-guided RIB, given in combination with the same volume of different concentrations of ropivacaine, would improve the whole quality of recovery-40 (QoR-40) among patients with VATS.Approaches: This double-blinded, single-center, prospective, and controlled trial randomized 100 patients undergoing VATS to receive RIB. One hundred patients who have received elective VATS and satisfied inclusion standards were fallen into four groups randomly: control group with no RIB and R0.2%, R0.3%, and R0.4%; they underwent common anesthesia plus the RIB with ropivacaine at 0.2%, 0.3%, and 0.4% in a volume of 30mL.Outcomes: Groups R0.2%, R0.3%, and R0.4% displayed great diversities in the overall QoR-40 scores and QoR-40 dimensions (in addition to psychological support) by comparing with the control group (Group C) (p<0.001 for all contrasts). Group R0.3% and R0.4% displayed great diversities in the overall QoR-40 scores and QoR-40 dimensions (in addition to psychological support) by comparing with the R0.2% group (p<0.001 for all contrasts). The overall QoR-40 scores and QoR-40 dimensions (physical comfort [p=0.585]) did not vary greatly between the Group R0.3% and R0.4% (p>0.05 for all contrasts). Group R0.2%, R0.3% and R0.4% showed significant differences in numerical rating scales (NRS) score region under the curve (AUC) at rest and on movement in 48 hours when compared with the Group C (p<0.001 for all contrasts). Group R0.3% and R0.4% displayed great diversities in NRS score AUC at rest and on movement in 48 hours when compared with the R0.2% group (p<0.001 for all contrasts). The NRS mark AUC at rest and on movement in 48 hours did not vary greatly between the Group R0.3% and R0.4% (p>0.05 for all contrasts).Conclusion: It was found that a dose of 0.3% ropivacaine is the best concentration for RIB for patients undergoing VATS. Through growing ropivacaine concentration, the analgesia of the RIB was not improved greatly.Trial registration number: ChiCTR2100046254

scholarly journals Rhomboid intercostal block combined with sub-serratus plane block versus rhomboid intercostal block for postoperative analgesia after video-assisted thoracoscopic surgery: a prospective randomized-controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Deng ◽  
Xiao-min Hou ◽  
Xu-yan Zhou ◽  
Qing-he Zhou
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Ultrasound Guided ◽  
Video Assisted ◽  
Prospective Randomized Controlled Trial ◽  
Numerical Rating ◽  
Intercostal Block ◽  
Video Assisted Thoracoscopic Surgery

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.

scholarly journals Ultrasound Guided Erector Spinae Plane Catheter Versus Video-Assisted Paravertebral Catheter Placement in Minimally Invasive Thoracic Surgery: Comparing Continuous Infusion Analgesic Techniques on Early Quality of Recovery, Respiratory Function and Chronic Persistent Surgical Pain: Study Protocol for A Double-Blinded Randomised Controlled Trial.

2021 ◽  
Author(s):  
Aneurin Moorthy ◽  
Aisling Ni Eochagain ◽  
Eamon Dempsey ◽  
Donal Buggy
Keyword(s):  
Thoracic Surgery ◽  
Short Form ◽  
Controlled Trial ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Quality Of Recovery ◽  
Video Assisted ◽  
Randomised Controlled ◽  
Double Blinded

Abstract Background: Compared to conventional thoracotomy, minimally invasive thoracic surgery (MITS) can reduce postoperative pain, reduce tissue trauma and contribute to better recovery. However, it still causes significant acute post-operative pain. Truncal regional anaesthesia techniques such as paravertebral and Erector Spinae blocks have shown to contribute to post-operative analgesia after MITS. Satisfactory placement of an ultrasound guided thoracic paravertebral catheter can be technically challenging compared to ultrasound guided Erector Spinae catheter. However, in MITS an opportunity arises for directly visualised placement of a paravertebral catheter by the surgeon under thoracoscopic guidance. Alongside with thoracic epidural, paravertebral block is considered the “gold standard” of thoracic regional analgesic techniques. To best of our knowledge, there are no randomised controlled trials comparing Surgeon-administered Paravertebral catheter and Anaesthesiologist-assisted Erector Spinae catheter for MITS in terms of patient centred outcomes such as quality of recovery.Methods: This trial will be a prospective, double-blinded randomised controlled trial. A total of 80 eligible patients will be randomly assigned to receive either an Anaesthesiologist-assisted ultrasound guided Erector Spinae catheter or Surgeon-assisted video-assisted Paravertebral catheter, in a 1:1 ratio following induction of general anaesthesia for minimally assisted thoracic surgery. Both groups will receive the same standardized analgesia protocol for both intra and postoperative periods. The primary outcome is defined as Quality of Recovery (QoR-15) score between the two groups at 24 & 48 hours postoperative. Secondary outcomes include assessment of chronic persistent surgical pain (CPSP) at 3 months post-operative using Brief Pain Inventory (BPI) Short Form and Short Form McGill (SF-15) questionnaires, assessment of post-operative pulmonary function, area Under the Curve for Verbal Rating Score for pain at rest and on deep inspiration versus time over 48 hours, total opioid consumption over 48 hours and post-operative complications and morbidity as measured by the Comprehensive Complication Index. Discussion: Despite surgical advancements in thoracic surgery, severe acute post-operative pain following MITS is still prevailing. This study will provide recommendations about the efficacy of anaesthesia-administered ultrasound guided Erector Spinae catheter or surgeon-administered, video assisted paravertebral catheter techniques for early quality of recovery following MITS. Trial registration: This trial was pre-registered on ClinicalTrials.gov Identifier: NCT04729712. Registered on 28 January 2021. All item from the World Health Organisation Trial Regsitration Data set have been included. https://clinicaltrials.gov/ct2/show/NCT04729712

scholarly journals Ultrasound-guided single erector spinae plane block versus thoracic paravertebral block for patients undergoing video-assisted thoracoscopic lobectomy: a randomized controlled trial

2019 ◽  
Author(s):  
Danxu Ma ◽  
Huilong Ren ◽  
Xueyang Li ◽  
Huili Li ◽  
Jia Jiang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Postoperative Analgesia ◽  
Controlled Trial ◽  
Erector Spinae ◽  
Control Group ◽  
Ultrasound Guided ◽  
Thoracic Paravertebral Block ◽  
Randomized Controlled ◽  
Video Assisted ◽  
Vas Scores

Abstract Background: Whether erector spinae plane (ESP) block can replace thoracic paravertebral block (TPVB) remains unknown. This study aimed to determine the efficacy and safety of ultrasound-guided ESP block compared with TPVB for postoperative analgesia after video-assisted thoracoscopic lobectomy under general anesthesia. Methods: This prospective randomized controlled trial divided patients into a control group, a TPVB group (0.3 mL/kg, 0.5% ropivacaine), and an ESP group (0.5 mL/kg, 0.5% ropivacaine). Dermatomes with loss of pinprick sensation, heart rate, and mean arterial pressure were recorded during 30 min after block administration. Visual analog scale (VAS) scores, total analgesic dose, and complications after surgery were recorded. Results: No obvious hemodynamic fluctuations occurred in the TPVB and ESP groups within 30 min after block administration. The segmental dermatomes with loss of pinprick sensation 30 min after regional block were 4.5 (1.1) dermatomes (T3–T7) in the TPVB group and 5.4 (1.2) dermatomes (T2–T8) in the ESP group. At 1 and 6 h after operation, VAS scores were lower in the TPVB group than in the control group (rest: 1h, P<0.001, 6h, P=0.004; cough: 1h, P<0.001, 6h, P<0.001), but at 18, 24, and 48 h, there was no significant difference (rest: 18h, P=0.18, 24h, P>0.99, 48h, P> 0.99; cough: 8h, P>0.99, 24h, P>0.99, 48h, P>0.99). VAS scores were similar in the TPVB and ESP groups at 1 h postoperatively (rest: P>0.99, cough: P>0.99), but were lower in the ESP group at 6, 18, 24, and 48 h (rest: 6h, P=0.018, 18h, P<0.001, 24h, P< 0.001, 48h, P<0.001; cough: 6h, P=0.004, 18h, P<0.001, 24h, P=0.004, 48h, P= 0.003). The doses of postoperative patient-controlled analgesia and rescue analgesia were lower in the TPVB and ESP groups than in the control group and were lower in the ESP group than in the TPVB group No block-related complications occurred. Conclusions: Single ESP block provided superior postoperative analgesia than TPVB, without causing any adverse effect.Trial registration: The study was approved by the ethics committee of Beijing Chaoyang Hospital (2017-ke-81). The trial was registered retrospectively at the Clinical Trial Registry of China (ChiCTR-INR-17011499) on May 26, 2017.

scholarly journals A randomised controlled trial of peri-operative pregabalin vs. placebo for video-assisted thoracoscopic surgery

Anaesthesia ◽  
2015 ◽  
Vol 71 (2) ◽  
pp. 192-197 ◽  
Author(s):  
A. H. Konstantatos ◽  
W. Howard ◽  
D. Story ◽  
L. Y. H. Mok ◽  
D. Boyd ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Video Assisted ◽  
Randomised Controlled ◽  
Video Assisted Thoracoscopic Surgery

Ultrasound-guided Serratus Anterior Plane Block Versus Thoracic Paravertebral Block on Alleviating the Acute and Chronic Pain Following the Video-assisted Thoracic Surgery: a Prospective, Randomized, Double-blinded Non-inferiority Clinical Trial

2021 ◽  
Author(s):  
Yan Wang ◽  
Jing Hao ◽  
Simin Huang ◽  
Xiaoping Gu ◽  
Zhengliang Ma
Keyword(s):  
Clinical Trial ◽  
Chronic Pain ◽  
Thoracic Surgery ◽  
Ultrasound Guided ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Vas Scores ◽  
Secondary Outcomes ◽  
Double Blinded ◽  
Anterior Plane

Abstract Background: The anesthetic efficacy of ultrasound-guided serrate anterior plane block (SAPB) on alleviating postoperative acute and chronic pain has been well concerned. The present study aims to compare the efficacy between ultrasound-guided SAPB and thoracic paravertebral block (PVB) on alleviating both acute pain and chronic pain following the video-assisted thoracic surgery. Methods: It was a prospective, randomized, double-blinded non-inferiority clinical trial involving 99 patients with lung nodules receiving video-assisted thoracic surgery with ultrasound-guided SAPB (SAPB group) or PVB (PVB group) on T4 and T7 vertebra using 0.375% ropivacaine at 2 mg/kg. The Visual Analogue Scale (VAS) scores at both rest and cough at 24 h postoperatively were graded as the primary outcome. Besides, secondary outcomes included the incidence of chronic pain at 3 and 6 months postoperatively, VAS scores at rest and cough at 1, 6, 12 and 48 h postoperatively, consumptions of fentanyl and remifentanyl, and the pressing times of the patient-controlled analgesia (PCA) pump. Baseline characteristics, surgery characteristics and primary and secondary outcomes between groups were compared. Results: A total of 92 eligible patients were recruited, including 46 in SAPB group and 46 in PVB group. Baseline and surgery characteristics between groups were comparable (all P>0.05). No significant differences in VAS scores at rest and cough at 1 h, 6 h, 12 h, 24 h, 48 h, 3 months and 6 months postoperatively between SAPB group and PVB group were detected (all P>0.05). Conclusion: The anesthetic efficacy of ultrasound-guided SAPB was not inferior to PVB on alleviating postoperative acute and chronic pain following the video-assisted thoracic surgery.Trial registration number: retrospective registered in the Chinese Clinical Trial Registry (ChiCTR2100050991, http://www.chictr.org.cn, 09/09/2021, Yan Wang, MD).

scholarly journals Comparative Effectiveness of Ultrasound-Guided Intratendinous Prolotherapy Injection with Conventional Treatment to Treat Focal Supraspinatus Tendinosis

Scientifica ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
John George ◽  
Shyan Ch’ng Li ◽  
Zulkarnain Jaafar ◽  
Mohamad Shariff A. Hamid
Keyword(s):  
Controlled Trial ◽  
Functional Score ◽  
Control Group ◽  
Shoulder Abduction ◽  
Ultrasound Guided ◽  
Range Of Movement ◽  
Regional Area ◽  
End Of Treatment ◽  
Conventional Physiotherapy ◽  
Randomised Controlled

Objective. To evaluate the efficacy of dextrose prolotherapy injection for focal supraspinatus rotator cuff tendinosis via outcomes such as functional score, range of movement, and real-time ultrasound parameters. Materials and Methods. 12 adult patients with focal supraspinatus tendinosis recruited after they had less than 30% improvement in functional (DASH) scores after one month of physiotherapy following initial presentation. Seven patients had 0.5–1.0 ml of prolotherapy injection (12.5% dextrose, 0.5% lignocaine) injected into the area of focal tendinosis under ultrasound guidance. Meanwhile, five patients continued standard physiotherapy with no intervention performed. Regional area of echogenicity in decibels, DASH, range of movements of the shoulder, pain, and sleep scores were measured at baseline and at 12 weeks. Results. The prolotherapy group showed significant improvement in shoulder abduction (p=0.030) and an improvement in sleep score (p=0.027). The echogenicity of area of tendinosis significantly increases at the end of treatment (p=0.009). However, there was a nonsignificant reduction in pain score in the injection group (43.5%) and in the control group (25%) at 12 weeks (p>0.005). Conclusion. Ultrasound-guided intratendinous prolotherapy injection significantly improves patient’s range of abduction and improves sleep within 12 weeks of treatment compared to conventional physiotherapy management. Trial Registration. This study was registered under Current Controlled Trials (UK) and given International Standard Randomised Controlled Trial Number (ISRCTN) of 43520960.

scholarly journals Azithromycin and hydroxychloroquine in hospitalised patients with confirmed COVID-19–a randomised double-blinded placebo-controlled trial

2021 ◽  
pp. 2100752
Author(s):  
Pradeesh Sivapalan ◽  
Charlotte Suppli Ulrik ◽  
Therese Sophie Lapperre ◽  
Rasmus Dahlin Bojesen ◽  
Josefin Eklöf ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Double Blind ◽  
Safety Outcome ◽  
Hospitalised Patients ◽  
Double Blinded ◽  
Combined Intervention

BackgroundCombining the antibiotic azithromycin and hydroxychloroquine induces airway immunomodulatory effects, with the latter also having in vitro antiviral properties. This may improve outcomes in patients hospitalised for COVID-19.MethodsPlacebo-controlled double-blind randomised multicentre trial. Patients ≥18 years, admitted to hospital for≤48 h (not intensive care) with a positive SARS-CoV-2 RT-PCR test, were recruited. The intervention was 500 mg daily azithromycin for 3 days followed by 250 mg daily azithromycin for 12 days combined with 200 mg twice daily hydroxychloroquine for all 15 days. The control group received placebo/placebo. The primary outcome was days alive and discharged from hospital within 14 days (DAOH14).ResultsAfter randomisation of 117 patients, at the first planned interim analysis, the data and safety monitoring board recommended stopping enrolment due to futility, based on pre-specified criteria. Consequently, the trial was terminated on February 1, 2021. A total of 61 patients received the combined intervention and 56 patients received placebo. In the intervention group, patients had a median of 9.0 DAOH14 (IQR, 3–11) versus. 9.0 DAOH14 (IQR, 7–10) in the placebo group (p=0.90). The primary safety outcome, death from all causes on day 30, occurred for 1 patient in the intervention group versus. 2 patients receiving placebo (p=0.52), and readmittance or death within 30 days occurred for 9 patients in the intervention group versus. 6 patients receiving placebo (p=0.57).ConclusionsThe combination of azithromycin and hydroxychloroquine did not improve survival or length of hospitalisation in patients with COVID-19.

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