The efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery: a randomized trial☆

Fibla, Juan J.; Molins, Laureano; Mier, José M.; Sierra, Ana; Carranza, Diego; Vidal, Gonzalo

doi:10.1016/j.ejcts.2010.12.043

Cited by 32 publications

(35 citation statements)

References 21 publications

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“…After confirmation that there was no dissemination, but before initiation of the thoracotomy, the paravertebral catheter was inserted in a manner that has been previously described [11–14], as follows: The upper edge of the spinous process of the T5 vertebral body was palpated through the skin. With the assistance of forceps inserted through the same camera port, the paravertebral space was visualized under thoracoscopy.…”

Section: Methodsmentioning

confidence: 99%

“…Our preliminary trials of thoracic PVB led us to suspect a strong correlation between a number of reported insertion methods [3, 4, 6–10] and substantial leak of local anesthetic into the pleural space, which results in less effective postoperative pain control. However, some authors have described the effectiveness of intraoperative percutaneous catheter placement during video-assisted thoracoscopic surgery (VATS) [11, 12]. This insertion method offers better pain control, as the extra-pleural space is closed above the catheter tip, allowing no leakage into the pleural space and facilitating easy coverage of more than one intercostal space.…”

Section: Introductionmentioning

confidence: 99%

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Continuous paravertebral block using a thoracoscopic catheter-insertion technique for postoperative pain after thoracotomy: a retrospective case-control study

Yamauchi

Isaka

Ando

et al. 2017

J Cardiothorac Surg

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BackgroundThoracic epidural analgesia (EDA) is the gold standard for pain control after thoracotomy. However, because of its severe side effects, it is contraindicated in patients taking anticoagulant or antiplatelet drugs. In addition, some patients’ anatomy can make epidural catheter insertion challenging. We therefore investigated the safety and efficacy of paravertebral block (PVB) using a thoracoscopic insertion technique, which avoids damage to the parietal pleura, for postoperative pain after thoracotomy.MethodsPatients who underwent thoracotomy with thoracic PVB in our hospital between March 2013 and March 2014 were examined retrospectively. Prior to creating the thoracotomy incision, a catheter for PVB was inserted percutaneously into the paravertebral space under thoracoscopic guidance. A matched-pair control group was selected at a 1:2 ratio from patients who underwent thoracotomy with thoracic EDA in our hospital from April 2011 to February 2013. Pain control and side effects were compared between groups and the results statistically analyzed.ResultsThoracic PVB was performed in 56 patients during this period, and 112 patients were selected as matched controls. Numeric Rating Scale scores on postoperative day 2 did not differ significantly between the PVB group (3.25 ± 1.80) and the EDA group (3.56 ± 2.05) (p = 0.334). In terms of side effects, urinary retention occurred less frequently in thoracic PVB patients (p = 0.03).ConclusionUnder the conditions of the present study, continuous thoracic PVB was at least as effective as epidural analgesia for postoperative pain control after thoracotomy with lung resection.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-017-0566-8) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Continuous paravertebral block using a thoracoscopic catheter-insertion technique for postoperative pain after thoracotomy: a retrospective case-control study

Yamauchi

Isaka

Ando

et al. 2017

J Cardiothorac Surg

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“…Paravertebral blocks (PVBs) are used often in the management of pain following thoracotomy, video-assisted thoracoscopic surgery, and mastectomy. [41][42][43] Much like epidural analgesia, their drawbacks include increased time for placement, but PVBs are not associated with a risk of paralysis or urinary retention. Studies have consistently illustrated the Volume 134, Number 4S-2 • Autologous and Implant-Based Breast Reconstruction 123S benefit of PVBs following mastectomy including decreased nausea and faster return to work.…”

Section: Nontraditionalmentioning

confidence: 99%

Putting It All Together

Wilson

Mirzabeigi

Serletti

2014

Plastic and Reconstructive Surgery

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“…After the surgical incision, the first pain sensation is mostly nociceptive; commonly, the use of NSAIDs is theoretical. One RCT of a small number of TS wedge resections (n=40) reported improved pain relief and reduced morphine consumption when PVB with ropivacaine was compared with IV NSAIDs using paracetamol plus metamizol (18). The authors concluded that the analgesic regimen combining PVB and NSAID provides an excellent level of pain control (19).…”

Section: Multimodal Analgesic Regimen Non-opioidsmentioning

confidence: 99%

Analgesic management after thoracoscopic surgery: recent studies and our experience

Kuroda

Sakao

2018

J. Thorac. Dis.

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Thoracoscopic surgery (TS) is a less invasive procedure t h a n o p e n t h o r a c o t o m y b e c a u s e i t i n v o l v e s l e s s postoperative pain, a lower complication rate, a shorter time to ambulation, and shorter hospitalization. Clinically, patients who undergo TS do not always harbor mild-tomoderate postoperative pain. Additionally, the insufficient management of postoperative pain might lead to the development of chronic pain. We previously reported that individual pain scores after TS are classified as no and mild (0-3/10), moderate (4-6/10), and severe (7-10/10) using the numerous rating scale (NRS). In an analysis of 524 patients who underwent TS, the incidence of mild pain was 87.0% on the operative day and 75.6% during ambulation (1). The mean NRS score after TS in patients who received a single-shot intercostal nerve block (INB) using ropivacaine was 1.83±1.49 on the operative day, 2.73±1.75 during ambulation, and 1.87±1.33 during settling, after receiving several analgesic drugs after TS, whereas the mean NRS score was 3.05±1.51 during ambulation after open thoracotomy in patients who received paravertebral block (PVB) or epidural analgesia (EA); thus, pain scores were significantly higher after open thoracotomy than TS (P<0.01) (1).However, there is still no consensus regarding optimal pain management after TS. In the present editorial, we focus on clinical acute post-thoracoscopic pain (APTP) and chronic post-thoracoscopic pain (CPTP) management after TS with reference to recent studies and our experience. APTP APTP after TS, including neuropathic pain, is likely a type of nociceptive pain that occurs from tissue trauma. Nociceptive pain occurs when thoracic tissues, such as intercostal muscles, pleura, ribs, and intercostal nerves, are impaired, and the continuous stimulus is perceived as painful. In our previous data, 13.0% and 24.4% of patients experienced moderate or severe pain on the operative day and during ambulation, respectively, and those patients with pain had a higher probability of requiring plural analgesics (1). Kaplowitz et al. determined that acute control is important for the following two reasons: to prevent splinting and stretching of the surgical incisions as a result of breathing and to help provide effective pre-emptive analgesia (2). Regional analgesia (EA/PVB/INB/multimodal analgesic regimen)EA EA is the gold standard for thoracotomy. In 312 patients who underwent pneumonectomy at the 24 United Kingdom thoracic surgical centers in 2005, the most common type of analgesia used was epidural (61.1%), followed by paravertebral infusion (31%) (3). Despite being the most common analgesia after thoracic surgery, its frequent side effects, including urinary retention (42%), nausea (22%), itching (22%), and hypotension as a result of decreased Editorial

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The efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery: a randomized trial☆

Cited by 32 publications

References 21 publications

Continuous paravertebral block using a thoracoscopic catheter-insertion technique for postoperative pain after thoracotomy: a retrospective case-control study

Continuous paravertebral block using a thoracoscopic catheter-insertion technique for postoperative pain after thoracotomy: a retrospective case-control study

Putting It All Together

Analgesic management after thoracoscopic surgery: recent studies and our experience

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