Efficacy of Preoperative Bilateral Thoracic Paravertebral Block in Cardiac Surgery Requiring Full Heparinization: A Propensity-Matched Study

Naganuma, M.; Tokita, Takaharu; Sato, Yuri; Kasai, Tatsuya; Kudo, Yasusei; Suzuki, Nobuaki; Masuda, Shinji; Nagaya, Koichi

doi:10.1053/j.jvca.2021.05.001

Cited by 13 publications

(5 citation statements)

References 17 publications

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“…In a previous study, local anesthetics had extended outside the paravertebral space after PVB in 40% of cases [ 26 ]. Therefore, PVB is effective for somatic analgesia during thoracic, cardiac, chest wall, and breast surgeries [ 27 , 28 , 29 , 30 ]. In particular, the superior costotransverse ligament, extending from the lower edge of the transverse process to the upper edge of the rib beneath, constitutes the posterior boundary of the paravertebral space [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Surgeon-Performed Thoracic Paravertebral Block on Postoperative Pain in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Controlled Trial

Lee,

Kim,

Park

et al. 2024

JPM

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Posterior spinal fusion for adolescent idiopathic scoliosis (AIS) causes severe postoperative pain. Thoracic paravertebral block (PVB) provides excellent analgesia during various surgeries. We examined the effects of PVB on postoperative analgesia in children undergoing AIS surgery. In this study, 32 children scheduled for AIS surgery were randomly assigned to receive either PVB (PVB group) or no block (control group). The PVB group underwent surgeon-performed PVB with 0.5 mL/kg of adrenalized 0.2% ropivacaine on each side. The primary outcome was the pain score at rest at 6 h postoperatively. Secondary outcomes included pain scores both at rest and during movement and analgesic use for 48 h postoperatively. The postoperative resting pain scores at 6 h were comparable between the control and PVB groups (5.2 ± 2.0 and 5.1 ± 1.8, respectively), with no significant differences. However, at 1 h postoperatively, the control group showed significantly higher resting and mean moving pain scores than the PVB group (p < 0.05). The pain scores at other time points and analgesic use were comparable between the groups. Initial benefits of surgeon-performed bilateral PVB were observed but diminished at 6 h postoperatively. Future research using various anesthetics is needed to extend the effects of PVB.

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Section: Discussionmentioning

confidence: 99%

Effect of Surgeon-Performed Thoracic Paravertebral Block on Postoperative Pain in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Controlled Trial

Lee,

Kim,

Park

et al. 2024

JPM

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“…The application of the PIP block technique, encompassing both superficial parasternal intercostal plane block (SPIP) and DPIP, for the purpose of blocking the anterior branches of intercostal nerves, has garnered increasing attention in the field of cardiac surgery involving sternotomy. Numerous studies have demonstrated that the administration of bilateral single-shot DPIP blocks, as an integral component of multimodal analgesia, effectively mitigates sternotomy pain levels for a duration of 24 h subsequent to open cardiac surgery [ 9 , 17 , 24–26 ]. Our research specifically focuses on the utilization of preoperative DPIP to proficiently diminish nociceptive stimulation originating from surgical interventions, thereby conferring the advantage of facilitating the maintenance of hemodynamic stability throughout the entirety of surgery, as compared to conventional opioid-based regimens.…”

Section: Discussionmentioning

confidence: 99%

Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study

Chen,

Li,

Liao

et al. 2023

Annals of Medicine

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Objective The precise characteristics of deep parasternal intercostal plane block (DPIP), which is useful for providing analgesia during open heart surgery, have not yet been thoroughly elucidated. In this study, we aimed to establish the efficacy, define the cutaneous sensory block area, and determine the duration of preemptive DPIP block at the T3-4 or T4-5 intercostal spaces in patients undergoing coronary artery bypass grafting (CABG) via sternotomy. Design A prospective, single-blind, randomized controlled trial. Setting Patients were randomly divided into three cohorts, each containing thirty patients. Participants Ninety patients who underwent elective CABG via sternotomy were included in this study. Interventions The T3-4 and T4-5 groups received a preoperative single-shot DPIP block at the respective intercostal spaces. The principal objective of the study was to ascertain the optimal dosage of sufentanil administered during surgical procedures involving either a DPIP block or its absence, and to conduct a comparative analysis thereof across distinct injection sites, specifically T3-4 and T4-5. Secondary factors considered were the dosage of postoperative analgesics, the extent of sensory block on the skin, pain levels after extubation, time of recovery from anesthesia (time to extubation), duration of the block, and the occurrence of nausea and vomiting. Measurements & Main Results Preemptive DPIP block significantly reduced intraoperative sufentanil requirement compared to the control group (T3-4:0.38 ± 0.1, T4-5:0.32 ± 0.10, vs. Control:0.88 ± 0.3 μg/kg/h, p < 0.001). It also resulted in decreased analgesic consumption and numeric rating scale scores on the day of surgery ( p < 0.01 compared to the control group). The DPIP block provided accurate anesthetic coverage of the dermatomes in the sternal region and reduced the time to extubation and postoperative nausea. However, the injection point (either via the T3-4 intercostal or the T4-5 intercostal) did not affect the efficacy. Preoperative DPIP block failed to provide adequate analgesia beyond 24 h post-surgery. Conclusion Preemptive bilateral DPIP block provided effective analgesia in patients undergoing CABG during surgery and in the early postoperative period. The analgesic effects of the DPIP block in the T3-4 and T4-5 intercostal spaces were comparable.

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“…PVB may confer an advantage over neuraxial technique given lower risk of epidural hematoma, though hypotension can still result from retrograde local distribution. One propensity-matched study showed that patients who received bilateral PVB for sternotomy required less intraoperative fentanyl and had higher likelihood of intra- and immediate postoperative extubation compared to general anesthesia alone [37 ▪ ]. Another study found that patients randomized to bilateral ultrasound-guided PVB experienced similar pain scores and rates of rescue analgesia compared to those who received TEA, suggesting that TEA is not a superior modality [38 ▪ ].…”

Section: Paravertebral Blockmentioning

confidence: 99%

Regional analgesia for cardiac surgery

Grant

Gregory

Ouanes

2022

Current Opinion in Anaesthesiology

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Purpose of review Regional anesthesia is gaining attention as a valuable component of multimodal, opioid-sparing analgesia in cardiac surgery, where improving the patient's quality of recovery while minimizing the harms of opioid administration are key points of emphasis in perioperative care. This review serves as an outline of recent advancements in a variety of applications of regional analgesia for cardiac surgery. Recent findingsGrowing interest in regional analgesia, particularly the use of newer ''chest wall blocks'', has led to accumulating evidence for the efficacy of multiple regional techniques in cardiac surgery. These include a variety of technical approaches, with results consistently demonstrating optimized pain control and reduced opioid requirements. Regional and pain management experts have worked to derive consensus around nerve block nomenclature, which will be foundational to establish best practice, design and report future research consistently, improve medical education, and generally advance our knowledge in this vital area of perioperative patient care.

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Efficacy of Preoperative Bilateral Thoracic Paravertebral Block in Cardiac Surgery Requiring Full Heparinization: A Propensity-Matched Study

Cited by 13 publications

References 17 publications

Effect of Surgeon-Performed Thoracic Paravertebral Block on Postoperative Pain in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Controlled Trial

Effect of Surgeon-Performed Thoracic Paravertebral Block on Postoperative Pain in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Controlled Trial

Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study

Regional analgesia for cardiac surgery

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