Efficacy and Safety of Continuous Paravertebral Block after Minimally Invasive Radical Esophagectomy for Esophageal Cancer

Abstract

Objective. To compare the effects of continuous paravertebral block analgesia and patient-controlled intravenous analgesia after minimally invasive radical esophagectomy for esophageal cancer and their effects on postoperative recovery. Methods. A retrospective analysis was performed among 233 patients who underwent minimally invasive esophageal cancer radical operation and met the requirements, including 87 patients (group C) who were successfully placed with a continuous paravertebral block device under direct vision and 146 patients (group P) who used a patient-controlled intravenous analgesia device. Visual analogue pain score (VAS) at rest and in motion for 1, 3, 6, 12, 24, 36, and 48 hours after awakening, incidence of adverse reactions of the two analgesic methods, occurrence of pulmonary complications after operation, use of emergency analgesics, and hospital stay after operation was recorded. Results. The VAS scores of group C in resting and active state at 1, 3, 6, 12, 24, 36, and 48 hours after operation were significantly lower than those of group P (P<0.001). The incidence of adverse reactions, pulmonary complications, and the use of emergency analgesics in group C were lower than those in group P (P<0.05). The hospitalization time of group C was significantly shortened, and the satisfaction degree of group C was significantly higher than that of group P (P<0.05). Conclusion. Paravertebral block is safe and effective for patients undergoing minimally invasive radical esophagectomy. The incidence of adverse reactions and complications is lower, and the satisfaction of postoperative analgesia is higher, which is beneficial to the rapid recovery of patients after operation.

Effect of Single-Injection Thoracic Paravertebral Block via the Intrathoracic Approach for Analgesia After Single-Port Video-Assisted Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial

“…However, the requirements for ultrasound imaging and block technology are high, the operation space is limited and the difficulty is greater, the success rate is low. There is a possibility of puncturing the pleura and damaging the intercostal nerve or sympathetic chain [8,21,23,24]. Compared with TPB, erector spinae plane block has a higher success rate, but requires higher ultrasound imaging and block technique [19].…”

Feasibility and effectiveness of multi-injection thoracic paravertebral block via the intrathoracic approach for analgesia after thoracoscopic-laparoscopic esophagectomy

“…The second method is to place the catheter in the paravertebral space through percutaneous puncture outside the pleura under thoracoscopic direct vision, this can achieve a similar continuous block as the catheter placed under ultrasound guidance. TPB can effectively reduce both the postoperative pain and consumption of opioids after thoracic surgery [7,24,26,27]. Both TPBs require at least three to five minutes during the procedure, possibly longer if the action is not smooth.…”

The effects of regional anesthesia combined with awake delayed extubation in patients undergoing esophageal cancer surgery: a single-blind randomized controlled trial

“…Regional analgesia techniques seem to be effective in postoperative management. Zhang et al reported that continuous paravertebral block alleviated the pain of patients in the resting and active state for patients undergoing MIE, which enabled patients to get out of bed early, cough and sputum effectively, and decreased the incidence of pulmonary complications [7]. Postoperative pain in MIE mainly comes from the trauma of thoracic and abdomen, especially originated from the upper abdominal incision [15].…”

“…Ideal postoperative analgesia contributes to the patient's cough and expectoration, and would decrease complications such as hypoxemia, atelectasis, and pulmonary infection. Zhang et al reported that continuous paravertebral block analgesia increased the satisfaction of postoperative analgesia and decreased the incidence of pulmonary complications for patients undergoing minimally invasive esophagectomy (MIE) [7]. However, Brovman found that the regional anesthetic techniques were not associated with a lower incidence of pulmonary complications in lobectomy surgery [8].…”