Ultrasound-guided Thoracic Paravertebral Block for Postoperative Pain Treatment after Thoracoscopic Surgery

Abstract Introduction: Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Attention is increasingly paid to its premium analgesia in urological surgery. Therefore, we aimed to explore whether ESPB would have similar analgesia compared with thoracic paravertebral block (TPVB) in laparoscopic nephroureterectomy surgery.Methods and analysis: This prospective, randomized, double-blinded, non-inferiority trial will enroll 166 patients undergoing laparoscopic nephroureterectomy. Participants will be randomly assigned 1:1 into receiving ESPB or TPVB before surgery. Both ultrasound-guided ESPB or TPVB will be performed with an injection of 0.375% ropivacaine 0.4ml/kg before anesthesia induction. Standardized patients controlled intravenous analgesia (PCIA) will be applied for each patient. The primary endpoint is the joint of cumulative 24h opioid (sufentanil) consumption and average pain score via numeric rating scale (NRS) at 24th h after surgery. Secondary endpoints include rescued analgesic demand, cumulative opioid consumption and pain NRS scores at different preset timepoint within 48h after surgery. Other predefined outcomes include clinical features of blockage, quality of recovery, subjective sleep quality, time to ambulation and flatus, and adverse events, as well as length of stay in hospital and anesthesia cost. Discussion: Previous studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparation between ESPB and TPVB in urological surgery is still lacking. Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy surgery, and the primary outcome is the joint endpoint of opioid consumption and pain NRS score.Trial registration: Chinese Clinical Trial Registry, ChiCTR 2000031916. Registered on 14 April 2020. http://www.chictr.org.cn/showproj.aspx?proj=50782

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Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery

European Journal of Anaesthesiology ◽

10.1097/eja.0000000000000945 ◽

2019 ◽

Vol 36 (4) ◽

pp. 272-278 ◽

Cited By ~ 6

Author(s):

Yasuko Taketa ◽

Yumi Irisawa ◽

Taro Fujitani

Keyword(s):

Continuous Infusion ◽

Thoracoscopic Surgery ◽

Paravertebral Block ◽

Ultrasound Guided ◽

Thoracic Paravertebral Block ◽

Bolus Infusion ◽

Intermittent Bolus ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

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Ultrasound-guided erector spinae plane block versus thoracic paravertebral block on postoperative analgesia after laparoscopic nephroureterectomy: study protocol of a randomized, double-blinded, non-inferiority design trial

Trials ◽

10.1186/s13063-021-05173-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhen-Zhen Xu ◽

Xue Li ◽

Zhen Zhang ◽

Zheng-Ye Liu ◽

Lin-Lin Song ◽

...

Keyword(s):

Postoperative Pain ◽

Opioid Consumption ◽

Paravertebral Block ◽

Erector Spinae ◽

Ultrasound Guided ◽

Thoracic Paravertebral Block ◽

Erector Spinae Plane Block ◽

Urological Surgery ◽

Double Blinded ◽

Laparoscopic Nephroureterectomy

Abstract Introduction Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Regional block is advocated in order to decrease opioid consumption and improve analgesia in urological surgery. Therefore, we aimed to explore whether ESPB would have similar analgesia compared with thoracic paravertebral block (TPVB) in laparoscopic nephroureterectomy. Methods and analysis This prospective, randomized, double-blinded, non-inferiority trial will enroll 166 patients undergoing laparoscopic nephroureterectomy. Participants will be randomly assigned 1:1 into receiving ESPB or TPVB before surgery. Both ultrasound-guided ESPB and TPVB will be performed with an injection of 0.375% ropivacaine 0.4 ml/kg before anesthesia induction. Standardized patients controlled intravenous analgesia (PCIA) will be applied for each patient. The primary endpoint is the joint of cumulative 24 h opioid (sufentanil) consumption and average pain score via numeric rating scale (NRS) at 24 h after surgery. Secondary endpoints include rescued analgesic demand, cumulative opioid consumption, and pain NRS scores at different preset timepoints within 48 h after surgery. Other predefined outcomes include clinical features of blockage, quality of recovery, subjective sleep quality, time to ambulation and diet, and adverse events, as well as length of stay in hospital and anesthesia cost. Discussion Previous studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparison between ESPB and TPVB in urological surgery are still lacking. Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy, and the primary outcome is the joint endpoint of opioid consumption and pain NRS score. Trial registration Chinese Clinical Trial Registry ChiCTR 2000031916. Registered on 14 April 2020.

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Distribution of injectate administered through a catheter inserted by three different approaches to ultrasound-guided thoracic paravertebral block: a prospective observational study

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101545 ◽

2020 ◽

Vol 45 (11) ◽

pp. 866-871 ◽

Cited By ~ 1

Author(s):

Sivaporn Termpornlert ◽

Shinichi Sakura ◽

Yuki Aoyama ◽

Aumjit Wittayapairoj ◽

Koji Kishimoto ◽

...

Keyword(s):

Thoracoscopic Surgery ◽

Transverse Process ◽

Sensory Block ◽

Paravertebral Block ◽

Ultrasound Guided ◽

Paravertebral Space ◽

Sensory Blockade ◽

Thoracic Paravertebral Block ◽

Catheter Tip ◽

Tip Position

BackgroundDespite the popularity of continuous thoracic paravertebral block (TPVB), there is a paucity of information on catheter tip position and distribution of injectate through the catheter. We observed, in real time, the spread of dye, the catheter tip position and sensory block levels produced with three different (intercostal (IC), transverse process sagittal (TS) and paralaminar (PL)) approaches to ultrasound-guided TPVB in patients undergoing video-assisted thoracoscopic surgery.MethodsAfter the induction of general anesthesia, ultrasound-guided TPVB was conducted with a patient in the lateral decubitus position. During surgery, 10 mL of dye was injected through a catheter to observe the catheter tip and the dye distribution under thoracoscopy. Dermatomal sensory block levels were measured postoperatively.ResultsTen patients for each of three different approaches completed the study. There were a variety of dye spreading patterns. The median (range) number of segmental levels stained with dye was 1.5 (1–4), 3 (1–4) and 3 (1–5) with the IC, TS and PL approaches, respectively. We observed that a catheter tip was present at the same segmental paravertebral space as intended in 50%–90% of patients using these approaches. The median (range) number of dermatomes with sensory blockade at 6 hours after block was 2.5 (1–4), 3 (2–8) and 3 (1–8) with the IC, TS and PL approaches, respectively.ConclusionsAlthough a bolus injection through a catheter for ultrasound-guided TPVB produced multiple levels of spread and sensory blockade in more than half the patients, considerable differences existed in the spread regardless of approach.

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