Bilateral thoracic Paravertebral block for immediate postoperative pain relief in the PACU: a prospective, observational study

Liu, Fei; Zhang, HuanKai; Zuo, Yunxia

doi:10.1186/s12871-017-0378-3

Cited by 11 publications

(7 citation statements)

References 21 publications

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“… 39 – 45 We observed that subjects of group RD had better postoperative analgesia and less pain intensity at all time points with decreased PCA use during the first postoperative 72 h compared with those of group S. In addition, perineural dexamethasone was superior to a single injection of ropivacaine for decreasing acute pain and reducing PCA machine use at 24 h after thoracotomy. Our data agreed with previous results that perineural dexamethasone can prolong analgesic duration 21 , 46 – 48 by decreasing nociceptive C fiber activity via direct modulation of glucocorticoid receptors. 21 …”

Section: Discussionsupporting

confidence: 93%

Efficacy of perineural dexamethasone with ropivacaine in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: a randomized, double-blind, placebo-controlled trial

Mao¹,

Zuo²,

Mei³

et al. 2018

JPR

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PurposeThe purpose of this study was to assess the efficacy of perineural dexamethasone with ropivacaine in multimodal analgesia for thoracic paravertebral block (TPVB) in patients undergoing elective thoracotomy.Patients and methodsNinety-six patients undergoing thoracotomy were enrolled in this trial and randomized to adjuvant therapy for TPVB: group S (saline), group R (0.5% ropivacaine), or group RD (5 mg dexamethasone and 0.5% ropivacaine). Postoperative analgesia, recovery duration, and chronic pain were recorded.ResultsGroups R and RD spent less time in the postanaesthesia care unit, had earlier out-of-bed activity, and had shorter postoperative hospital stays compared with group S. The RD group regained consciousness faster and had lower acute pain scores and used less patient-controlled analgesia during the first 72 h after surgery compared with group S. Postthoracotomy pain was decreased in group RD (19.0%) compared with group S (47.6%) 3 months postoperatively, p = 0.050.ConclusionPerineural dexamethasone with ropivacaine for TPVB improves postoperative analgesia quality, reduces recovery time, and may decrease the incidence of chronic pain after thoracotomy with an opioid-based anesthetic regimen.

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Section: Discussionsupporting

confidence: 93%

Efficacy of perineural dexamethasone with ropivacaine in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: a randomized, double-blind, placebo-controlled trial

Mao¹,

Zuo²,

Mei³

et al. 2018

JPR

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“…Our findings were consistent with a previous study on sixty patients undergoing elective nephrectomy; they reported that dexamethasone administered as an adjuvant to 0.25% bupivacaine for TPVB, lowered the pain score, prolonged the duration of analgesia and decreased the consumption of rescue opioids in the first 24 h in comparison to 0.25% bupivacaine alone. [ 15 ] In addition,[ 21 ] an observational study to investigate the effectiveness and safety of bilateral TPVB in the PACU, which was used to alleviate pain in participants following laparotomy, concluded that bilateral TPVB with an injection of 25 ml of 0.2% ropivacaine and 5 mg dexamethasone led to a rapid reduction of pain scores at rest and on cough and omitted the need for rescue analgesia in patients with exaggerating pain. The effective analgesia with quick onset could be explained by the enhancement of local anaesthetic penetration to the spinal nerve in the thoracic paravertebral space since they are devoid of both epineurium and a part of the perineurium, with just a thin membranous root sheath.…”

Section: Discussionmentioning

confidence: 99%

Effects of adding dexamethasone or ketamine to bupivacaine for ultrasound-guided thoracic paravertebral block in patients undergoing modified radical mastectomy: A prospective randomized controlled study

Mourad

Amer

2018

Indian J Anaesth

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Background and Aims:Pain after modified radical mastectomy (MRM) has been successfully managed with thoracic paravertebral block (TPVB). The purpose of this study was to evaluate the effect of adding dexamethasone or ketamine as adjuncts to bupivacaine in TPVB on the quality of postoperative analgesia in participants undergoing MRM.Methods:This prospective randomised controlled study enrolled ninety adult females scheduled for MRM. Patients were randomised into three groups (30 each) to receive ultrasound-guided TPVB before induction of general anaesthesia. Group B received bupivacaine 0.5% + 1 ml normal saline, Group D received bupivacaine 0.5% + 1 ml dexamethasone (4 mg) and Group K received bupivacaine 0.5% + 1 ml ketamine (50 mg). Patients were observed for 24 h postoperatively to record time to first analgesic demand as a primary outcome, pain scores, total rescue morphine consumption and incidence of complications.Results:Group K had significantly longer time to first analgesic demand than group D and control group (18.0 ± 6.0, 10.3 ± 4.5 and 5.3 ± 3.1 hours respectively; P = 0.0001). VAS scores were significantly lower in group D and group K compared to control group at 6h and 12 h postoperative (p 0.0001 and 0.0001 respectively) while group K had lower VAS at 18 hours compared to other two groups (P = 0.0001). Control group showed the highest mean 24 h opioid consumption (8.9 ± 7.9 mg) compared to group D and group K (3.60 ± 6.92 and 2.63 ± 5.24 mg, P = 0.008,0.001 respectively). No serious adverse events were observed.Conclusion:Ketamine 50 mg or dexamethasone 4 mg added to bupivacaine 0.5% in TPVB for MRM prolonged the time to first analgesic request with no serious side effects.

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“… 89 Thoracic PVB reduced pain at rest and on cough after laparotomy in the PACU and appeared to be a promising analgesic technique for abdominal surgery in terms of efficacy and safety. 90 , 91 Compared to the anatomic landmark-guided PVB, an ultrasound-guided PVB needed more local anesthetic, but there was no difference between the two approaches regarding perioperative opioid use, PACU pain scores, and complications; moreover, the latter one benefited better performance of junior physicians. 92 …”

Section: Regional Anesthesia Techniquesmentioning

confidence: 99%

Postoperative pain management in the postanesthesia care unit: an update

Luo

Min

2017

JPR

103

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Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients’ participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities. Multimodal analgesia with different analgesics and techniques has been widely used. With theoretical basis of preventing central sensitization, preventive analgesia is increasingly common. New opioids are being developed with minimization of adverse effects of traditional opioids. More intravenous nonopioid analgesics and adjuncts (such as dexmedetomidine and dexamethasone) are introduced for their opioid-sparing effects. Current evidence suggests that regional analgesic techniques are effective in the reduction of pain and stay in the PACU. Being available alternatives to epidural analgesia, perineural techniques and infiltrative techniques including wound infiltration, transversus abdominis plane block, local infiltration analgesia, and intraperitoneal administration have played a more important role for their effectiveness and safety.

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Bilateral thoracic Paravertebral block for immediate postoperative pain relief in the PACU: a prospective, observational study

Cited by 11 publications

References 21 publications

Efficacy of perineural dexamethasone with ropivacaine in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: a randomized, double-blind, placebo-controlled trial

Efficacy of perineural dexamethasone with ropivacaine in thoracic paravertebral block for postoperative analgesia in elective thoracotomy: a randomized, double-blind, placebo-controlled trial

Effects of adding dexamethasone or ketamine to bupivacaine for ultrasound-guided thoracic paravertebral block in patients undergoing modified radical mastectomy: A prospective randomized controlled study

Postoperative pain management in the postanesthesia care unit: an update

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