A Comparative Study of Automated Pulsed Bolus Versus Continuous Basal Infusion on Distribution of Dye in the Paravertebral Space in a Cadaver

Clendenen, Steven R.; Bojaxhi, Elird

doi:10.7759/cureus.4958

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…2A. The median dermatomes with loss of pinprick sensation were 5 (4)(5)(6)(7) in the successful blocks. The median upper level was T3 (T2-T3) and lower level was T7 (T6-T8) (Fig.…”

Section: Resultsmentioning

confidence: 88%

“…It is a widely used analgesic technique for thoracic, chest wall, breast, urologic, abdominal or orthopedic surgery [1][2][3][4][5]. One characteristic of TPVB is the unpredictability of local anesthetic spreading in the paravertebral space [6][7][8]. It is very important to assess the outcome of TPVB to ensure the expected analgesic effects.…”

Section: Introductionmentioning

confidence: 99%

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Infrared Thermography for Assessment of Thoracic Paravertebral Block: A Prospective Observational Study

Zhang

Liu

et al. 2021

Preprint

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Background: There was no “gold standard” to assess the success or failure of thoracic paravertebral block (TPVB). Measurement of skin temperature with infrared thermography (IT) would be a reliable method to evaluate the effectiveness of regional blocks. This study aimed to explore the feasibility of using skin temperature difference (Td) determined by IT between the blocked and unblocked side to predict the outcome of TPVB. Methods: Sixty-one patients undergoing elective unilateral breast or thoracoscopic surgery were enrolled in this prospective observational study. TPVB was performed at T4 and T5 under real-time ultrasound guidance with 10 mL of 0.4% ropivacaine for each patient, respectively. Td between the blocked and unblocked side were measured with IT from T2 to T10 at the anterior chest wall before TPVB and 5 min, 10 min, 15 min and 20 min after TPVB. Pinprick test was performed at 20 min after TPVB. Successful TPVB was defined as no sensation to pinprick in 3 or more adjacent dermatomes corresponding to the site of injection at 20 min after TPVB. Td was compared to pinprick test for evaluating its effectiveness in predicting the success of TPVB. The sensitivity, specificity, and cut-off value of Td for predicting successful TPVB were determined by receiver operator characteristic (ROC) curve analysis.Results: Compared with the baseline value before block, Td from T2 to T10 were significantly increased at each time point in successful blocks. In failed blocks, Td was not increased in any dermatome. The increase of Td at T4-T7 was more than 1℃ 20 min after successful TPVB. Fifteen minutes after block, Td increase at T4 had the greatest potential to predict block success. The area under the ROC curve was 0.960 at a cut-off value of 0.63℃ with a sensitivity of 83.3% and a specificity of 100.0%.Conclusions: This study suggested that the increase of Td at T4 dermatome determined by IT between the blocked and unblocked side is an early, quantitative, and reliable predictor of successful TPVB. Clinical trial registration: NCT04078347

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“…2A. The median dermatomes with loss of pinprick sensation were 5 (4)(5)(6)(7) in the successful blocks. The median upper level was T3 (T2-T3) and lower level was T7 (T6-T8) (Fig.…”

Section: Resultsmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Infrared Thermography for Assessment of Thoracic Paravertebral Block: A Prospective Observational Study

Zhang

Liu

et al. 2021

Preprint

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“…A possible explanation for this clinical result is the high pressure achieved by modern pumps during bolus infusions 15 , which allow better spread of the infusion solution. This bene t has already been proven in one cadaveric study studying dye dispersion in the paravertebral space with bolus infusion 16 . Another evidence of this effect was established in the study by Hida et al, who found a wider dermatomal spread of the paravertebral block with paravertebral bolus infusion after video-assisted thoracoscopy but noted no differences in pain scores 10 .…”

Section: Discussionmentioning

confidence: 85%

Intermittent Bolus Versus Continuous Paravertebral Infusion on Postoperative Pain after Unilateral Mastectomy: A Retrospective Cohort Study.

Volio

Kim

Skolaris

et al. 2021

Preprint

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Background: Persistent pain is a common complication after mastectomy for breast cancer, and postoperative analgesia through paravertebral infusion is a promising technique for pain control after mastectomy. Although paravertebral local anesthetic infusion can be performed using continuous or intermittent bolus modes, there is no evidence of superiority of either infusion mode.Methods: We retrospectively studied patients who had undergone unilateral mastectomy with paravertebral catheter placed for postoperative analgesia between October 2017 and September 2018. Logistic regression was created to estimate the relative risk for moderate to severe pain defined by average pain scores greater than 4 using a 0 to 10 Numeric Rating Scale (NRS) within first 24 hours after surgery. Opioid consumption was compared using a Student T-test for difference in means using the log-transformed cumulative opioid consumption converted to milligrams of oral morphine equivalents (OME) within the first 48 hours after surgery.Results: 49 patients were included (continuous infusion group: 14; bolus infusion group: 35). Bolus paravertebral infusion was associated with reduction of relative risk of moderate to intense pain (adjusted relative risk: -0.96; 95%CI: -1.81, -0.1; p = 0.029) but there was no association with reduction in opioid consumption (difference of means: -1.4mg of OME; 95%CI: -2.78, 1.42; p = 0.33).Conclusion: Intermittent bolus infusion was associated with reduction of relative risk for moderate to severe postoperative pain for unilateral mastectomies. Therefore, paravertebral catheter infusion modality may influence postoperative pain experience after unilateral mastectomies.

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“…As discussed above, periodic bolusing administration thus might be an interesting alternative in terms of higher kinetic energy input, better drug distribution, and improved therapeutic effects. Superiority of bolus compared to continuous administration in terms of drug distribution has been demonstrated in other anatomical compartments, such as epidural (182), or paravertebral spaces (183). In a separate small pilot study, 10 patients with chronic pain were randomized to two periods of continuous administration of intrathecal opioid or bolus regime (40% of daily dose split into four equal boli applied every 6 h, with the remaining 60% as background continuous infusion), in a crossover fashion (184).…”

Section: Delivery Programming and Outcomementioning

confidence: 99%

Intrathecal Drug Delivery: Advances and Applications in the Management of Chronic Pain Patient

et al. 2022

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Advances in our understanding of the biology of spinal systems in organizing and defining the content of exteroceptive information upon which higher centers define the state of the organism and its role in the regulation of somatic and automatic output, defining the motor response of the organism, along with the unique biology and spatial organization of this space, have resulted in an increased focus on therapeutics targeted at this extracranial neuraxial space. Intrathecal (IT) drug delivery systems (IDDS) are well-established as an effective therapeutic approach to patients with chronic non-malignant or malignant pain and as a tool for management of patients with severe spasticity and to deliver therapeutics that address a myriad of spinal pathologies. The risk to benefit ratio of IDD makes it a useful interventional approach. While not without risks, this approach has a significant therapeutic safety margin when employed using drugs with a validated safety profile and by skilled practioners. The present review addresses current advances in our understanding of the biology and dynamics of the intrathecal space, therapeutic platforms, novel therapeutics, delivery technology, issues of safety and rational implementation of its therapy, with a particular emphasis upon the management of pain.

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A Comparative Study of Automated Pulsed Bolus Versus Continuous Basal Infusion on Distribution of Dye in the Paravertebral Space in a Cadaver

Cited by 4 publications

References 8 publications

Infrared Thermography for Assessment of Thoracic Paravertebral Block: A Prospective Observational Study

Infrared Thermography for Assessment of Thoracic Paravertebral Block: A Prospective Observational Study

Intermittent Bolus Versus Continuous Paravertebral Infusion on Postoperative Pain after Unilateral Mastectomy: A Retrospective Cohort Study.

Intrathecal Drug Delivery: Advances and Applications in the Management of Chronic Pain Patient

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