Thoracic paravertebral and erector spinae plane block: A cadaveric study demonstrating different site of injections and similar destinations

Diwan, Sandeep; Garud, Rajendra; Nair, Abhijit

doi:10.4103/sja.sja_339_19

Cited by 26 publications

(15 citation statements)

References 4 publications

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“…Furthermore, there is no consensus regarding the volume of local anesthetics to be administered. In a cadaveric study, Diwan et al have postulated that the effect of ESPB occurs via the spread in epidural and paravertebral spaces [13]. It was observed in another cadaveric study that as the volume of the anesthetic increased in ESPB, the spread to the posterior muscles and fascial layers increased predominantly compared to the extent of the paravertebral spread [23].…”

Section: Discussionmentioning

confidence: 99%

“…The number of case reports and the number of prospective randomized controlled studies about US-guided ESBP are increasing in the literature. In general, comparative studies on TPVB and ESPB are conducted and their analgesic effects are evaluated in studies [12][13]. It is known that the use of analgesic drugs and techniques in combination yields a multimodal effect leading to the increased analgesic efficiency, especially in patients with intense postoperative pain such as patients undergoing thoracic surgery [1,14].…”

Section: Introductionmentioning

confidence: 99%

“…It is known that the use of analgesic drugs and techniques in combination yields a multimodal effect leading to the increased analgesic efficiency, especially in patients with intense postoperative pain such as patients undergoing thoracic surgery [1,14]. Consensus has not been reached yet about the spread of local anesthetics in anatomical spaces and the volume to be administered in regional analgesia, which is part of multimodal regimens in the treatment of pain after thoracic surgery [13,15]. Therefore, considering that the analgesic effect would possibly be increased by combining TPVB and the newly introduced technique, ESPB, we aimed to evaluate the effects of the combination of TPVB and ESPB particularly on postoperative pain scores in patients undergoing VATS.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery

Zengin¹,

Baldemir²,

Ulger³

et al. 2021

Cureus

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BackgroundThe combination of a thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) has not been investigated. We aimed to evaluate the effects of the combination of TPVB and ESPB particularly on postoperative pain scores in patients undergoing video-assisted thoracic surgery (VATS). MethodsFrom January 1, 2021, to March 1, 2021, 13 patients older than 18 years who underwent combined ESPB and TPVB for analgesic treatment after elective VATS were included in the study. Standard anesthesia induction was performed for all patients, and the block was performed in the lateral decubitis position before surgery. Using the in-plane technique, an ultrasound (US)-compatible 22-gauge, 8-mm nerve block needle was introduced 2-3 cm lateral to the spinous process of the T6 vertebra and advanced in the caudocranial direction. Fifteen (15) ml of 0.25% bupivacaine was administered and pleural depression was observed. The same needle was withdrawn from the paravertebral space and advanced into the interfascial plane above the transverse process and below the erector spinae muscle at the T5 level. Then, 15 ml of 0.25% bupivacaine was injected. ResultsThe combination of TPVB and ESPB was performed in 13 patients. The mean age was 44.3 (21-68) years. The mean body mass index (BMI) was 23.21 (16.9-35.9) kg/m 2 . Postoperative 24 hours morphine consumption was 24.5 (16-42) mg. In three cases, visual analog scale (VAS) scores at rest were ≥4; therefore, tramadol (25 mg, IV) was given as an additional analgesic. Nausea and vomiting were observed in only one case in the early postoperative period. ConclusıonsAs a new technique, the combination of TPVB and ESPB in this preliminary study provided effective postoperative pain management along with the use of morphine in acceptable quantities. Large-scale, randomized-controlled, and comparative studies are needed to demonstrate the efficacy of the combination of TPVB and ESPB.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery

Zengin¹,

Baldemir²,

Ulger³

et al. 2021

Cureus

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“…Cadaveric and radiocontrast studies depict a dorsal and a ventral spread into the PVS. [ 6 7 ] In our case series, the spread from the ESPB was in the thoracic PVS in both the patients at the level of T5.…”

mentioning

confidence: 58%

Spread of local anesthetic after thoracic erector spinae and thoracic paravertebral block in patients with multiple posterolateral rib fractures

Diwan

Nair

2020

Saudi J Anaesth

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“…[ 7 10 11 12 13 14 15 16 ] Though the mechanism of action is still not fully understood, it has been demonstrated in cadaveric and in vivo studies that one of the prime mechanisms is by drug penetration into the paravertebral region. [ 17 18 19 ] A study by Ivanusic et al ., 20 failed to demonstrate any spread into the paravertebral space.…”

Section: Discussionmentioning

confidence: 99%

Comparison of erector spinae plane block and local anaesthetic infiltration of the incision site for postoperative analgesia in percutaneous nephrolithotomy – A randomised parallel-group study

Ramachandran

Ramaraj

Velayudhan

et al. 2021

Indian Journal of Anaesthesia

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Background and Aims: Erector spinae plane block (ESPB) has been found effective in providing postoperative analgesia following a myriad of surgeries. This study was designed to evaluate the effectiveness of ultrasonography (USG) guided erector spinae plane block to provide postoperative analgesia following percutaneous nephrolithotomy (PCNL). Methods: This was a prospective, double-blinded, randomised parallel-group study conducted in patients undergoing PCNL. Patients in Group C (n = 33) received subcutaneous infiltration of 20 mL of 0.25% bupivacaine at the incision site and Group B (n = 33) received USG guided ESPB with 20 mL of 0.25% bupivacaine postoperatively. Numeric rating scale (NRS) scores were assessed at intervals of 30 min, 60 min, then hourly for six h, followed by four-hourly up to 24 h. The primary objective of the study was to compare postoperative pain relief using the NRS score between the two groups. Secondary objectives were to compare the analgesic requirement and to assess the incidence of complications. Normally distributed data were expressed as mean and standard deviation and analysed using Student's t-test. Data following non-normal distribution were expressed as median and interquartile range and analysed using Mann- Whitney U-test. For categorical data, the Chi-square test was used. Results: NRS scores were lower in Group B than Group C. There was significant prolongation in time for first analgesia in Group B (12 h) compared to Group C (30 min). There was a significant reduction in total tramadol consumption at 24 h postoperatively in the ESPB group. Conclusion: Ultrasound-guided ESPB is an efficacious analgesic technique with an opioid-sparing effect following PCNL.

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Thoracic paravertebral and erector spinae plane block: A cadaveric study demonstrating different site of injections and similar destinations

Cited by 26 publications

References 4 publications

Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery

Postoperative Analgesic Efficacy of Thoracic Paravertebral Block and Erector Spinae Plane Block Combination in Video-Assisted Thoracic Surgery

Spread of local anesthetic after thoracic erector spinae and thoracic paravertebral block in patients with multiple posterolateral rib fractures

Comparison of erector spinae plane block and local anaesthetic infiltration of the incision site for postoperative analgesia in percutaneous nephrolithotomy – A randomised parallel-group study

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