Ultrasound versus thoracoscopic-guided paravertebral block during thoracotomy

Abstract

Background Paravertebral block can be performed with the aid of surgical landmarks, ultrasound, or a thoracoscope. This study was designed to compare ultrasound-guided paravertebral block with the thoracoscopic technique. Methods This prospective randomized comparative study included 40 adults scheduled for elective thoracic surgery. Study participants were randomized to an ultrasound group or a thoracoscope group. A catheter for paravertebral block was inserted prior to thoracotomy with real-time ultrasound visualization in the ultrasound group, and under thoracoscopic guidance in the thoracoscope group. Total analgesic consumption, visual analogue pain score, technical difficulties, and complications were compared between the 2 groups. Results Total analgesic consumption in the first 24 hours was less in the ultrasound group than in the thoracoscope group (rescue intravenous fentanyl 121.25 ± 64.01 µg in the ultrasound group vs. 178.75 ± 91.36 µg in the thoracoscope group; p = 0.027). Total paravertebral bupivacaine consumption was 376.00 ± 33.779 mg in the ultrasound group and 471.50 ± 64.341 mg in the thoracoscope group ( p < 0.001). Technical difficulties and complications in terms of time consumed during the maneuver, more than one needle pass, and pleural puncture were significantly lower in the ultrasound group than in the thoracoscope group. Conclusion Ultrasound-guided paravertebral catheter insertion is more effective, technically easier, and safer than the thoracoscope-assisted technique.

Effects of Different Doses of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block Anesthesia on Agitation and Hemodynamics in Patients Undergoing Thoracotomy during Recovery

“…Interestingly, there was no significant difference in the incidence of complications among the four groups. These findings suggest that ropivacaine alone and 0.5 μ g·kg −1 dexmedetomidine plus ropivacaine cannot effectively inhibit the intubation reaction of patients during surgery, while the doses of 1.0 μ g·kg −1 and 1.5 μ g·kg −1 dexmedetomidine plus ropivacaine can effectively reduce and control hemodynamics [ 18 ]. This may have been due to that the doses of 1.0 μ g·kg −1 and 1.5 μ g·kg −1 dexmedetomidine play a key role in reducing and controlling the stress response of patients.…”

“…This would suggest that 1.0 μ g·kg −1 and 1.5 μ g·kg −1 doses of dexmedetomidine combined with ropivacaine exert good sedative and analgesic effects, without prolonging the recovery time of patients or raising the risk of complications [ 19 ]. The possible mechanism is that (1) dexmedetomidine, as a μ -opioid receptor agonist, can effectively block the release of norepinephrine, thereby weakening nerve signal transmission and ultimately reducing postoperative adverse symptoms such as hyperalgesia [ 18 ]; (2) dexmedetomidine can also reduce interleukin and inflammatory factors such as tumor necrosis factors, reduce the excitability of nerves, and thus reduce the pain of patients [ 19 ]; (3) dexmedetomidine can enhance the sympathetic nerve activity of patients and inhibit the occurrence of postoperative hyperalgesia from both positive and negative aspects [ 20 ]; (4) dexmedetomidine also has a certain antinociceptive effect, which further relieves pain and improves the sedation degree of patients [ 21 ].…”

The Role of Ultrasound-Guided Multipoint Fascial Plane Block in ElderlyPatients Undergoing Combined Thoracoscopic–Laparoscopic Esophagectomy: A Prospective Randomized Study

“…Incisional infiltration to block the anterior serratus is also commonly used to reduce postoperative pain. The advantage of this technique is that it can provide prolonged pain relief, has a low probability of local anesthetic poisoning and complications, and is relatively simple to perform [ 23 – 25 ].…”

Regional Anesthesia With Paravertebral Blockade Is Associated With Improved Outcomes in Patients Undergoing Minithoracotomy Cardiac Surgery

“…[11][12][13][14][15] Paravertebral (PV) catheterbased regional anesthesia is regarded as one of the most promising options for providing regional anesthesia in cardiac surgical patients and has been studied in depth for patients undergoing thoracic surgical procedures. [14][15][16][17] Nevertheless, further research is required to identify its efficacy and safety profile in patients undergoing MICS.…”