Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery †

Vogt, Andreas; Stieger, D. S.; Theurillat, C.; Curatolo, Michele

doi:10.1093/bja/aei250

Cited by 153 publications

(112 citation statements)

References 24 publications

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“…Many methods of pain management, each with attendant problems, have been tried with varied success, for example: intercostal nerve block (1;2), intrapleural analgesia (3;4), cryoanalgesia (5;6), lumbar epidural (7;8), thoracic epidural (9;10), paravertebral block (11)(12)(13), IV narcotics (8;14;15), intrathecal (16)(17)(18) or epidural (2;15;19;20) narcotics, NSAIDS (1;21;22), and transcutaneous nerve stimulation (23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%

Postthoracotomy Pain Management Problems

Gerner

2008

Anesthesiology Clinics

227

130

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SynopsisPain after thoracotomy is very severe, probably the most severe pain experienced after surgery. It is also unique as this pain state has multiple implications, including respiratory failure due to splinting; inability to clear secretions by effective coughing, with resulting pneumonia; and facilitation of the often incapacitating chronic pain: the post-thoracotomy pain syndrome. Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the 'gold standard' for pain management after thoracotomy. This view has recently been challenged by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of the post-thoracotomy pain syndrome remain the most important challenges for post-thoracotomy pain management.

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Section: Introductionmentioning

confidence: 99%

Postthoracotomy Pain Management Problems

Gerner

2008

Anesthesiology Clinics

227

130

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“…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%

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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“…Gulbahar et al [14] compared epidural and Para vertebral continuous block for elective posterolateral thoracotomy and concluded that both the technique are equally effective in post-operative pain management. Detterbeck et al [15] conducted a review of prospective, randomized studies for pain relief after thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Paravertebral Block Versus Thoracic Epidural Block for Post - Operative Analgesia in Thoracotomy Patients

Bisht¹,

Patel²

2015

jemds

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BACKGROUND:Thoracotomy is associated with severe postoperative pain and impaired pulmonary function leading to delayed recovery. Thoracic epidural block is a popular technique for pain management. Paravertebral block is an alternate technique providing ipsilateral analgesia. AIM: To compare the efficacy of Paravertebral and epidural block for postoperative analgesia in thoracotomy patients. METHODS: This study was conducted on 50 patients undergoing thoracotomy divided into two groups of 25 each. Group I received paravertebral injection of 0.25% 15 ml bupivacaine between T5 & T9 levels. Group II received epidural injection of 0.25% 15 ml bupivacaine between T5 & T9 levels. We studied the quality and duration of analgesia and the complications. The effects on the respiratory mechanics were also studied. RESULTS: After 20 minutes of injecting the drug, the VAS in group I dropped to a mean of 2.2±0.41, while in group II it was 1. The difference was not significant for the next 9 hours. The mean duration of effective analgesia in group I was 8.96 ± 1.31 hours while in group II it was 7.80±1.91 hours. The PEFR was higher in paravertebral group for 6 hours. After 20 minutes of drug administration PEFR in group I was 144±20.41ml/mt, while in group II it was 120.8±18.69ml/mt (p<0.001). Three hours later, the scores were 167.66±15.51ml/mt and 138.4±24.6ml/mt respectively (p<0.001). The same was seen till next 6 hours. 6 patients in group II had hypotension.1 patient in group II had both hypotension and urinary retention. The incidence of nausea and vomiting were comparable. CONCLUSIONS: Thoracic epidural block of bupivacaine provides excellent post-operative analgesia but is associated with hypotension and urinary retention. Paravertebral block provides a superior analgesia and being unilateral there is no incidence of sympathetic block. It also reduces early loss of post-operative pulmonary functions and rapidly restores respiratory mechanics.

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Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery †

Abstract: We conclude that single-shot preoperative paravertebral block improves post-operative pain treatment after thoracoscopic surgery in a clinically significant fashion.

Cited by 153 publications

References 24 publications

Postthoracotomy Pain Management Problems

Postthoracotomy Pain Management Problems

Placement of coiled catheters into the paravertebral space*

Comparison of Paravertebral Block Versus Thoracic Epidural Block for Post - Operative Analgesia in Thoracotomy Patients

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