Extradural, paravertebral and intercostal nerve blocks for post-thoracotomy pain

Perttunen, K; Nilsson, E.; Heinonen, Jussi S.; Hirvisalo, E L; Salo, Jarmo A.; Kalso, Eija

doi:10.1093/bja/75.5.541

Cited by 135 publications

(102 citation statements)

References 20 publications

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“…The intercostal nerves were reached in all cases by the contrast. The median IQR [range] cranio-caudal spread of dye was 4 (4-5 [3][4][5][6][7][8]) thoracic segments; in one case, a significant portion reached the pre-vertebral space. In 11 ⁄ 20 (55%) cases, a small amount of contrast dye (approximately 1 ml) could be detected in the epidural space with a median IQR [range] cranio-caudal spread of 4 (2-7 [1-15])thoracic segments.…”

Section: Resultsmentioning

confidence: 99%

“…Paravertebral blockade is a regional anaesthetic technique that can be used for analgesia after thoracic surgery [1][2][3][4], cardiac surgery [5], breast surgery [6][7][8] or upper abdominal surgery [9], or for chronic pain therapy [10]. A thoracic paravertebral block is performed by injecting local anaesthetic solution into the paravertebral space, which contains the thoracic nerves, their branches and the sympathetic trunk.…”

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confidence: 99%

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Placement of coiled catheters into the paravertebral space*

et al. 2012

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SummaryThere are conflicting results with regard to the use of catheter-based techniques for continuous paravertebral block. Local anaesthetic spread within the paravertebral space is limited and the clinical effect is often variable. Discrepancies between needle tip position and final catheter position can also be problematic. The aim of this proof-of-concept study was to assess the reliability of placing a newly developed coiled catheter in human cadavers. Sixty Tuohy needles and coiled catheters were placed under ultrasound guidance, three on each side of the thoracic vertebral column in 10 human cadavers. Computed tomography was used to assess needle tip and catheter tip locations. No catheter was misplaced into the epidural, pleural or prevertebral spaces. The mean (SD) distance between catheter tips and needle tips was 8.2 (4.9) mm. The median (IQR [range]) caudo-cephalad spread of contrast dye injectate through a subset of 20 catheters was 4 (4-5[3-8]) thoracic segments. All catheters were removed without incident. Precise paravertebral catheter placement can be achieved using ultrasound-guided placement of a coiled catheter.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Placement of coiled catheters into the paravertebral space*

et al. 2012

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“…The only study comparing thoracic paravertebral block with intercostals nerve block was that of Perttunen and colleagues [20]. In their study the authors compared three analgesia techniques for postthoracotomy pain: extradural, paravertebral and intercostals nerve block.…”

Section: Citationmentioning

confidence: 99%

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

Cosmo

Federico²,

Sessa³

et al. 2013

J Anesthe Clinic Res

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Objectives: Thoracotomy is one of the most painful surgical stimuli and inadequate management of postthoracotomy pain is often associated with pulmonary and cardiac complications. The aim of this prospective, randomized, double-blinded study was to compare continuous paravertebral block versus continuous incisional infusion with OnQ Pain Relief System. Methods:Forty eight patients, undergoing thoracotomy for elective lobectomy, were randomized to receive a continuous paravertebral infusion of bupivacaine 0.25% through an elastomeric pump which delivers 0.1 mL/Kg/h (group A) or a continuous incisional infusion of bupivacaine 0.25% at an infusion rate of 4 mL/h with OnQ Pain Relief System (group B). Both infusions were started before wound closure, and continued for 48 postoperative hours. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient-controlled analgesia (PCA). Visual analogue scale at rest (VASr) and when coughing (VASi), rescue patientcontrolled analgesia morphine consumption, hemodynamic, time to ambulation and side-effects were evaluated within 48 h. Results:The two groups were comparable regarding to patients' number and characteristics, type of surgery, time to ambulation and side-effects; postoperative hemodynamic profile was stable in all the patients. Absolute pain scores were low in both groups; patients in group A reported significant lower VASr and VASi values during the postoperative 48 hours compared with group B (p<0.001). Total morphine consumption and PCA requests number were significantly lower in group A than in group B (p= 0.05 and p< 0.01).

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“…Various studies have been conducted with pain treatments such as intercostal nerve block, iv-PCA, and ketamine administration (5,7,27,28). However, the optimum method to treat post-thoracotomy pain is still controversial.…”

Section: Discussionmentioning

confidence: 99%

Impact of pregabalin on early phase post-thoracotomy pain compared with epidural analgesia

et al. 2017

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Background: The purpose of this randomized study was to compare the effects of pregabalin with epidural analgesia on early phase post-thoracotomy pain. Methods: This study was conducted on 90 adult patients who underwent thoracotomy. Patients were randomly divided into two groups, an epidural analgesia group, where 45 patients received 0.2% ropivacaine hydrochloride and fentanyl through a thoracic epidural catheter, and a pregabalin group, where 45 patients received 75 mg pregabalin orally twice daily. Both groups were also administered orally with celecoxib along with each treatment. Numerical rating scale (NRS) and sleep interference rate (SIR) were evaluated on the first day, third day, and fifth day after surgery. Anesthetic induction time, operation time, recovery time, the use of additional analgesic drugs and adverse effects were also examined. Results: NRS and SIR were significantly lower in the pregabalin group at all time points (P<0.05). The number of patients requiring additional analgesic drugs within 24 hours after surgery showed no difference between the two groups; however, the number was significantly decreased in the pregabalin group after post-operative day 1 (P<0.001). Adverse effects including pneumonia, dysuria, constipation and nausea were identified among many patients in the epidural analgesia group (P<0.05). Operation time and recovery time were the same for both groups, while the epidural analgesia group showed a significantly longer anesthetic induction time (P<0.001).Conclusions: Pregabalin is considered to be a safe and effective treatment method which is an alternative to epidural analgesia for acute post-thoracotomy pain.

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Extradural, paravertebral and intercostal nerve blocks for post-thoracotomy pain

Cited by 135 publications

References 20 publications

Placement of coiled catheters into the paravertebral space*

Placement of coiled catheters into the paravertebral space*

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

Impact of pregabalin on early phase post-thoracotomy pain compared with epidural analgesia

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