Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain Control Post-Cardiac Surgery: A Randomized Controlled Trial

Shora, Hatem A. El; Beleehy, Ahmed A. El; Abdelwahab, Amr A.; Ali, Gaser; Omran, Tarek E.; Hassan, Essam; Arafat, Amr A.

doi:10.1055/s-0038-1668496

Cited by 58 publications

(39 citation statements)

References 19 publications

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“…[ 12 ] Another two studies compared paravertebral block with thoracic epidural anesthesia (TEA). [ 13 14 ] While El shora et al . found comparable analgesia in both groups, Oliver and colleagues reported TEA to be superior.…”

Section: Discussionmentioning

confidence: 99%

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Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

Kar

Ramachandran

2020

Ann Card Anaesth

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Acute post-operative pain following sternotomy in cardiac surgery should be adequately managed so as to avoid adverse hemodynamic consequences and pulmonary complications. In the era of fast tracking, adequate and efficient technique of post-operative analgesia enables early extubation, mobilization and discharge from intensive care unit. Due to increasing expertise in ultrasound guided blocks there is a recent surge in trial of bilateral nerve blocks for pain relief following sternotomy. The aim of this article was to review non-neuraxial regional blocks for analgesia following sternotomy in cardiac surgery. Due to the paucity of similar studies and heterogeneity, the assessment of bias, systematic review or pooled analysis/meta-analysis was not feasible. A total of 17 articles were found to be directly related to the performance of non-neuraxial regional nerve blocks across all study designs. Due to scarcity of literature, comments cannot be made on the superiority of these blocks over each other. However, most of the reviewed techniques were found to be equally efficacious or better than conventional and established techniques.

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Section: Discussionmentioning

confidence: 99%

“…found comparable analgesia in both groups, Oliver and colleagues reported TEA to be superior. [ 13 14 ] This difference may be justified as due to lack of use of continuous infusion in the later. Further studies are required to support or refute these findings.…”

Section: Discussionmentioning

confidence: 99%

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

Kar

Ramachandran

2020

Ann Card Anaesth

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“…However, performing PVB is relatively complex, and there has been no breakthrough for traditional epidural analgesia yet. 18 With ongoing development in nerve block technology, newer PVB approaches have been the focus of many studies in recent years, such as RLB. It was speculated that RLB would be more inclined to work through the PVB pathway, that is, through “deep” penetration.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Ultrasound-Guided Retrolaminar Block of Multiple Injections in Retroperitoneal Laparoscopic Nephrectomy: A Prospective Randomized Controlled Study

Liu¹,

Xinpeng²,

Zhu³

et al. 2021

JPR

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Purpose Ultrasound-guided retrolaminar block (RLB) has the potential to provide postoperative analgesia in retroperitoneal laparoscopic surgery. This study was conducted to evaluate the effects of RLB when compared with local infiltration analgesia (LIA) in retroperitoneal laparoscopic nephrectomy. Patients and Methods One hundred and fifteen patients scheduled for laparoscopic nephrectomy were divided into two groups: the RLB group (n = 57) received an ultrasound-guided RLB, while the LIA group (n = 58) received LIA. At 2, 4, 6, 24, and 48 hours after operation, the maximal visual analog score (VAS), sufentanil and rescue analgesia consumption, and the utilization of patient-controlled intravenous analgesia (PCIA) were assessed. The incidence rates of postoperative nausea and vomiting (PONV); time of leaving bed (at the first instance); and the levels of plasma β-Endorphin (β-EP), Interleukin-1β (IL-1β), and prostaglandin E2 (PEG2) 30 min after extubation were noted. Results Patients in the RLB group had significantly lower VAS scores; lower sufentanil cumulative consumption; lower manual addition frequency of PCIA; lower proportion of using rescue analgesia within 48 hours after operation; lower incidence rate of PONV; shorter resuscitation times; earlier time of leaving the bed; and lower β-EP, IL-1 β, and PEG2 levels. Conclusion Ultrasound-guided RLB of multiple injections is both safe and controllable for postoperative analgesia after retroperitoneal laparoscopic nephrectomy. When compared with LIA, RLB has better and longer-lasting analgesic effect, lower incidence rates of PONV, and the potential to reduce the level of postoperative inflammatory factors. Trial Registration China Clinical Trials Registration Center ( http://www.chictr.org.cn , No. ChiCTR1800017526, Date of registration: 2018–08-02).

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“…The USG parasternal intercostal nerve block averted the negative side effects observed with other postoperative analgesia modalities, and epidural analgesia and paravertebral block, in cardiac surgery patients. Furthermore, these modalities are operatordependent and require experienced professionals for safe and quick application (28)(29)(30). In this study, parasternal intercostal nerve block under real-time ultrasound guidance was performed near the sternum by injecting ropivacaine between the external intercostal and pectoralis major muscles, resulting in a larger area of sensory deprivation in comparison with transversus thoracic muscle plane block (31).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided Parasternal Intercostal Nerve Block for Postoperative Analgesia in Mediastinal Mass Resection by Median Sternotomy: a Randomized, Double-blind, Placebo-controlled Trial

Chen

Song

Wang

et al. 2020

Preprint

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Background: Ultrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear. This study aimed to evaluate the effectiveness of ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in patients undergoing median sternotomy for mediastinal mass resection.Methods: This randomized, double-blind, placebo-controlled trial performed in Renmin Hospital, Wuhan University, enrolled 41 participants aged 18-65 years. The patients scheduled for mediastinal mass resection by median sternotomy were randomly assigned were randomized into 2 groups, and preoperatively administered 2 injections of ropivacaine (PSI) and saline (control) groups, respectively, in the 3rd and 5th parasternal intercostal spaces with ultrasound-guided (USG) bilateral parasternal intercostal nerve block. Sufentanil via patient-controlled intravenous analgesia (PCIA) was administered to all participants postoperatively. Pain score, total sufentanil consumption, and postoperative adverse events were recorded within the first 24 hours.Results: There were 20 and 21 patients in the PSI and control group, respectively. The PSI group required 20% less PCIA-sufentanil compared with the control group (54.05 ± 11.14 μg vs. 67.67 ± 8.92 μg; P < 0.001). In addition, pain numerical rating scale (NRS) scores were significantly lower in the PSI group compared with control patients, both at rest and upon coughing within 24 postoperative hours. Postoperative adverse events were generally reduced in the PSI group compared with controls. Conclusions: USG bilateral parasternal intercostal nerve block effectively reduces postoperative pain and adjuvant analgesic requirement, with good patient satisfaction, therefore constituting a good option for mediastinal mass resection by median sternotomy.

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Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain Control Post-Cardiac Surgery: A Randomized Controlled Trial

Abstract: This randomized parallel controlled trial demonstrates that ultrasound-guided paravertebral block is safe and effective method for relieving post-cardiac surgery sternotomy pain compared with thoracic epidural analgesia but not superior to it.

Cited by 58 publications

References 19 publications

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

Safety and Efficacy of Ultrasound-Guided Retrolaminar Block of Multiple Injections in Retroperitoneal Laparoscopic Nephrectomy: A Prospective Randomized Controlled Study

Ultrasound-guided Parasternal Intercostal Nerve Block for Postoperative Analgesia in Mediastinal Mass Resection by Median Sternotomy: a Randomized, Double-blind, Placebo-controlled Trial

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