Continuous Rhomboid Intercostal Block for Thoracoscopic Postoperative Analgesia

Deng, Wei; Liu, Fen; Jiang, Wei-chen; Sun, Yueming; Shi, Guping; Zhou, Qinghe

doi:10.1016/j.athoracsur.2021.06.068

“…Moreover, central neuraxial blocks achieved with TEA are associated with sympathetic nervous system blockade which contributes to postural hypotension induced nausea and vomiting [ 86 ]. RCTs directly comparing unilateral loco-regional techniques versus control groups without peripheral blocks demonstrate that PONV was significantly more prevalent in the control group [ 24 , 36 , 38 , 57 ]. Finally, most studies in the unilateral loco-regional technique groups provided prophylactic anti-emetic medication, also significantly reducing PONV incidence [ 14 , 24 , 57 , 64 , 72 , 80 ].…”

Section: Discussionmentioning

confidence: 99%

Acute pain management after thoracoscopic lung resection: a systematic review and explorative meta-analysis

Spaans

¹

,

Bousema

²

,

Meijer

³

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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Objectives Pain after thoracoscopic surgery may increase the incidence of postoperative complications and impair recovery. Guidelines lack consensus regarding postoperative analgesia. We performed a systematic review and meta-analysis to determine the mean pain scores of different analgesic techniques (thoracic epidural analgesia, continuous or single-shot unilateral regional analgesia and only systemic analgesia) after thoracoscopic anatomical lung resection. Methods Medline, Embase and Cochrane databases were searched until 1st of October 2022. Patients undergoing at least >70% anatomical resections through thoracoscopy reporting postoperative pain scores were included. Due to a high inter-study variability an explorative meta-analysis next to an analytic meta-analysis was performed. The quality of evidence has been evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Results A total of 51 studies comprising 5,573 patients were included. Mean 24, 48 and 72 hour pain scores with 95% confidence interval on a 0–10 scale were calculated. Length of hospital stay, postoperative nausea and vomiting, additional opioids and the use of rescue analgesia were analysed as secondary outcomes. A common-effect size was estimated with an extreme high heterogeneity for which pooling of the studies was not appropriate. An exploratory meta-analysis demonstrated acceptable mean pain scores of NRS <4 for all analgesic techniques. Conclusions This extensive literature review and attempt to pool mean pain scores for meta-analysis demonstrates that unilateral regional analgesia is gaining popularity over thoracic epidural analgesia in thoracoscopic anatomical lung resection, despite great heterogeneity and limitations of current studies precluding such recommendations. Prospero registration ID number 205311

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“…Te PVB is currently considered an optimal alternative to TEB because of the same analgesia efect and higher safety [6,7]. But the PVB also comes with some complications, such as pneumothorax, intercostal vascular injury, and paraspinal muscle pain [8][9][10][11]. Ultrasound-guided serrate anterior plane block (SAPB) is another strategy for alleviating postoperative pain, however, is noninferior to the PVB in analgesic for both acute and chronic pain 1-year post thoracoscopic surgery, and the SPAB applied safer and more patient-satisfying pain relief regimens [12].…”

Section: Introductionmentioning

confidence: 99%

“…Te ultrasound-guided rhomboid intercostal block (UG-RIB) is one of them, which was discovered by Elsharkawy et al in 2016 [13]. It has been reported that UG-RIB can ensure adequate analgesia in modifed radical mastectomy and VATS [11,14,15]. However, a comparison of the analgesic efcacy between RIB and PVB has yet to be reported.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Rhomboid Block versus Paravertebral Block in Postoperative Analgesia for Video-Assisted Thoracoscopic Surgery: A Prospective Randomized Controlled Clinical Trial

Wang

¹

,

Gu

²

,

Huang

³

et al. 2023

Pain Research and Management

3

0

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Introduction. The anesthetic efficacy of the ultrasound-guided rhomboid intercostal block (RIB) in alleviating postoperative pain has been well concerned. This study aims to compare the effectiveness between ultrasound-guided RIB and paravertebral block (PVB) in alleviating acute pain following video-assisted thoracic surgery. Methods. It was a prospective, randomized, double-blinded clinical trial involving 132 patients with video-assisted thoracic surgery divided into three groups: the general anesthesia (GA) group, RIB group, and PVB group on T5 vertebra, using 0.4% ropivacaine at 3 mg/kg, registered in the Chinese Clinical Trial Registry (ChiCTR2100054057, “https://www.chictr.org.cn”). The visual analogue scale (VAS) scores at rest and cough during 48 h postoperatively and the postoperative consumption of pain rescue were the primary outcomes, and the QoR15 score 48 h postoperatively, the usage of opioids during and after operation, and nerve block-related complications were the secondary outcomes. Demographic characteristics, surgery characteristics, and primary outcomes between the groups were compared. Results. A total of 120 eligible patients were recruited, including 40 in each group. Baseline and surgery characteristics between the groups were comparable (all p > 0.05 ). The PVB and RIB groups were better than the GA group in the primary and secondary outcomes ( p < 0.05 ). The static VAS score, QoR15 score, and block-related complications within 48 hours after surgery were better in the RIB group than in the PVB group ( p < 0.001 ). Conclusion. Both PVB and RIB can provide adequate analgesia and accelerate the recovery of patients. Compared with PVB, RIB has a better analgesic effect, especially to avoid paravertebral pain caused by block, and the operation of RIB is more straightforward and the safety is higher.

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“…Currently, several regional nerve blocks are used for analgesia after thoracic surgery, such as serratus plane block (SAB), erector spinae plane block (ESP), and rhomboid intercostal block (RIB). However, their analgesic effects vary in strength, and the question of which technique is safer and more effective is still controversial [7][8][9][10]. Further clinical studies are needed to answer this.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Rhomboid Intercostal Block, Erector Spinae Plane Block, and Serratus Plane Block on Analgesia for Video-Assisted Thoracic Surgery: A Prospective, Randomized, Controlled Trial

Zhang

¹

,

Jiang

²

,

Deng

³

et al. 2022

International Journal of Clinical Practice

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Background. Thoracic surgery is one of the most painful surgical steps. An important tool for managing postoperative pain is effective postoperative analgesia. This research aimed at comparing the analgesic roles of three new fascial block techniques in the postoperative period after video-helped thoracoscopic operation (VATS). Methods. We randomly allocated ninety patients into three teams experiencing ultrasound-directed serratus plane block, erector spinae plane block, and the rhomboid intercostal block, respectively. 0.4% ropivacaine of 20 mL was received by all groups. Outcomes. At 0–12 hours, sufentanil consumption was significantly lower in the RIB (35.2 ± 3.3 mg) and ESP (35.4 ± 2.8 mg) groups than that in the SAB (43.3 ± 2.7 mg) group P < 0.001 , and no obvious diversity in sufentanil consumption was shown between the RIB and ESP groups P = 0.813 . At 12–24 hours, sufentanil consumption was greatly lower in the RIB and ESP groups than that in the SAB group P < 0.001 , and no great diversity in sufentanil consumption was found between the RIB and ESP groups P = 0.589 . No great diversity in sufentanil consumption was shown between the RIB (50.4 ± 1.4 mg), ESP (50.4 ± 1.5 mg), and SAB (51.0 ± 1.7 mg) groups at 24–48 hours P = 0.192 . At 6, 12, 18, and 24 hours, the postoperative dynamic NRS scores were significantly lower in the RIB and ESP groups than in the SAB group ( P < 0.05 for all contrasts). Nevertheless, no great diversity was observed in postoperative pain marks at 0.5, 1, 3, 6, 12, 18, 24, 36, and 48 hours after the surgery across the three groups. No statistical diversity was found in the postoperative NRS mark between groups RIB and ESP within 48 hours after surgery in case of active patients ( P < 0.05 for all contrasts). At 24 hours after surgery, a significant difference in IL-1β and IL-6 inflammatory factor concentrations was found between RIB and ESP compared with SAB block ( P < 0.05 for all contrasts). However, no great diversities were observed in IL-1β, and IL-6 inflammatory factor concentrations between RIB, ESP, and SAB at 24 hours preoperatively and at 48 hours postoperatively ( P < 0.05 for all comparisons). Conclusion. The dosage of sufentanil can be effectively reduced by ultrasound-directed rhomboid intercostal block and erector spinae plane block within 24 hours after VATS surgery, and pain can be relieved effectively within 24 hours by comparing with serratus plane block.

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Continuous Rhomboid Intercostal Block for Thoracoscopic Postoperative Analgesia

Cited by 12 publications

References 20 publications

Acute pain management after thoracoscopic lung resection: a systematic review and explorative meta-analysis

Acute pain management after thoracoscopic lung resection: a systematic review and explorative meta-analysis

Ultrasound-Guided Rhomboid Block versus Paravertebral Block in Postoperative Analgesia for Video-Assisted Thoracoscopic Surgery: A Prospective Randomized Controlled Clinical Trial

Comparison of Rhomboid Intercostal Block, Erector Spinae Plane Block, and Serratus Plane Block on Analgesia for Video-Assisted Thoracic Surgery: A Prospective, Randomized, Controlled Trial

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