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

Abstract

Background We observed the feasibility and effectiveness of multi-injection thoracic paravertebral block (TPB) via the intrathoracic approach under thoracoscopic direct vision for analgesia after thoracoscopic-laparoscopic esophagectomy (TLE). Methods Sixty patients undergoing TLE were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the three levels of T2, 5, and 8 with a scalp needle before closing the chest. The patients in the observation group received 10 ml 0.375% ropivacaine at each level, and the patients in the control group received 10 ml of 0.9% saline at each level. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption, number of PCIA presses and use of rescue analgesia in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (rest and coughing) were recorded at 2 h, 6 h, 12 h, 24 h, and 48 h after surgery. The duration of postoperative hospital stay, active cough rate, first ambulation, and the incidence of adverse reactions after surgery was recorded. Results The sufentanil consumption in the observation group was significantly lower than that in the control group (34.7 ± 1.9 µg vs. 52.1 ± 2.1 µg; P < 0.001). The VAS score at each postoperative time point, number of PCIA presses, use of rescue analgesia, and the incidence of adverse reactions in the observation group were significantly lower than those in the control group. The postoperative active cough rate of patients in the observation group was significantly higher than those in the control group, and the times of the first ambulation after surgery and postoperative hospital stay in the observation group were significantly shorter than those in the control group (all P < 0.05). Conclusions Multi-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after TLE with fewer adverse reactions and contributing to improved postoperative recovery.

Efficacy and safety of Thoracoscopic-guided Paravertebral Block on the Early Postoperative Analgesia following Video-assisted Thoracoscopic Lobectomy: A Randomized Blinded Controlled Study

“…Additionally, the incidence of POVN in PVB group was signi cantly lower than that in the control group, which might be due to less consumption of sufentanil in PVB group. All the above-mentioned results in the present study were consistent with previous study which also supported the evidence that patients would bene t from improved postoperative analgesia with less systemic opioid consumption to obtain rapid recovery from surgery and avoid the corresponding complications after receiving PVB at the end of surgery [30].…”

Effect of Thoracoscopic-guided Paravertebral Block with Ropivacaine and Adjuvant Dexmedetomidine on the Early Postoperative Analgesia in Video-assisted Thoracoscopic Lobectomy: A Randomized Blinded Controlled Study

“…The incidence of POVN in PVB group was signi cantly lower than that in the control group, which might be due to less consumption of sufentanil in PVB group. All the above-mentioned results in the present study supported the evidence that patients would bene t from improved postoperative analgesia with less systemic opioid consumption to obtain rapid recovery from surgery and avoid the corresponding complications [33].…”

Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial

“…In previous studies, researchers have verified a novel technique for TPB, known as TTPB [ 8 , 9 , 18 ]. This technique involves a complete exposure of the thoracic vertebrae, paravertebral space, and intercostal space under the field of thoracoscopy.…”

“…Subsequently, 20 mL of 0.375% ropivacaine was injected (Fig. 2 ) [ 8 , 9 ]. The TTPB surgery was performed by the surgeon.…”

“…In previous studies, researchers have confirmed a novel technique for TPB, named thoracoscopy-guided thoracic paravertebral block (TTPB) (Fig. 1 ) [ 8 , 9 ]. This technique is easy to perform and can effectively reduce postoperative pain.…”