Which Is More Effective for Minimally Invasive Pectus Repair: Epidural or Paravertebral Block?

Aydın, Gülçin; Şahin, Ahmet Tuğrul; Gençay, Işın; Akcabay, Zeynep Nur; Günal, Nesimi; Dural, Koray; Özpolat, Berkant; Büyükkoçak, Ünase

doi:10.1089/lap.2019.0403

Cited by 5 publications

(2 citation statements)

References 20 publications

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“…In a comparison of paravertebral to epidural blocks, Aydin et al reported that patients had better pain management, decreased LOS, and increased satisfaction if they were administered either PVB or epidural block, compared to neither, prior to surgery [ 26 ]. However, the placement of epidural block or catheter carries risk for nerve injury.…”

Section: Discussionmentioning

confidence: 99%

A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children

et al. 2023

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Background Despite advancements in minimally invasive repair of pectus excavatum (MIRPE), Nuss procedure, postoperative pain control remains challenging. This report covers a multimodal regimen using bilateral single-shot paravertebral block (PVB) and bilateral thoracoscopic intercostal nerve (T3–T7) cryoablation, leading to significant reduction in length of stay (LOS) and high rate of same-day discharge. Methods This is a comparative study of pain management protocols for patients undergoing the Nuss procedure at a single center from 2016 through 2020. All patients underwent the the same surgical technique for the treatment of pectus excavatum at a single center. Patients received bilateral PVB with continuous infusion (Group 1, n = 12), bilateral PVB with infusion and right-side cryoablation (Group 2, n = 9), or bilateral single-shot PVB and bilateral cryoablation (Group 3, n = 17). The primary outcome was LOS with focus on same-day discharge, and the secondary outcome was decreased opioid usage. Results Eleven of 17 patients in Group 3 (65%) (bilateral single-shot PVB and bilateral cryoablation) were discharged the same day as surgery. The remaining Group 3 patients were discharged the following day with no complications or interventions. Compared to Group 1 (no cryoablation), Group 3 had shorter LOS (median 4.4 days vs. 0.7 days, respectively, p < 0.001) and significantly decreased median opioid use on the day of surgery (0.92 mg/kg vs. 0.47 mg/kg, p = 0.006). Conclusion Findings demonstrate the feasibility of multimodal pain management for same-day discharge after the Nuss procedure. Future multisite studies are needed to investigate the superiority of this approach to established methods. Level of Evidence III.

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Section: Discussionmentioning

confidence: 99%

A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children

et al. 2023

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“…Several studies have stated the importance of patient satisfaction in the process of eliminating postoperative pain. 18 In the current study, patient satisfaction was also considered to be of great importance in this process. A statistically significantly higher level of patient satisfaction was recorded…”

Section: Conflict Of Interest Statementmentioning

confidence: 93%

The efficacy of Erector Spinae Plane Block (ESPB) applied under ultrasonography guidance in percutaneous nephrolithotomy operations

Şahin¹,

Aydın²,

Alparslan³

et al. 2023

JOCS

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Aims: This study aimed to evaluate the effect of erector spinae block (ESPB) applied preoperatively under ultrasonography guidance in percutaneous nephrolithotomy (PNL) operations in terms of the intraoperative need for opioids, postoperative analgesia, and patient satisfaction. Methods: Of 60 patients who were 18 to 65-year-old and evaluated as American Society of Anesthesiologists (ASA) risk I-II-III were planned to undergo elective PNL. The patients were randomly separated into two groups as the Block group-administered ESPB under sedation in the preoperative period and the Control group-administered no ESPB. All the operations were performed under general anesthesia. The study data were analyzed using Mann-Whitney U-test and the Independent Samples t-test. Results: Demographic data of the patients were not different between the groups (p>0.05). Neither intraoperative opioids nor analgesics were required for any of the patients in the ESPB group whereas intraoperative opioids and analgesic drugs had to be administered to all of the patients in the control group (p<0.001). The postoperative patient satisfaction scores in the ESPB group were found statistically higher than that of the control group (p<0.001). Conclusion: The results demonstrated that ESPB applied preoperatively under USG guidance reduced the need for intraoperative opioids and postoperative analgesia in PNL operations. This, in turn, increased patient satisfaction by maintaining patient comfort after surgery.

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Safety and efficacy of high thoracic epidural analgesia for chest wall surgery in young adolescents

Coppens,

Dewinter,

Hoogma

et al. 2024

European Journal of Anaesthesiology

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BACKGROUND Chest wall surgery for the correction of pectus excavatum or pectus carinatum has gained increased interest in recent years. Adequate pain treatment, respiratory physiotherapy and early ambulation are key to improving the outcomes. Although thoracic epidural analgesia is highly effective, its safety is controversial, leading to extensive scrutiny and questioning of its role. OBJECTIVE(S) We hypothesise that thoracic epidural analgesia is effective and well tolerated to use in adolescents, with a high success rate and low pain scores. DESIGN Observational retrospective cohort study. SETTING All adolescent cases in a high-volume academic tertiary chest wall surgery centre between March 1993 and December 2017 were included. PATIENTS A total of 1117 patients aged from 12 to 19 years of age and receiving either Ravvitch, Nuss or Abramson chest wall reconstruction for pectus excavatum were identified in our institutional chest wall surgery database. After applying selection and exclusion criteria, 532 patients were included in the current analysis. MAIN OUTCOME MEASURES The primary endpoint of this study was the safety of epidural analgesia, assessed by the incidence of acute adverse events. Secondary endpoints were block success rates using a specific novel definition, and analgesic efficacy using recorded postoperative pain scores. RESULTS More than 60% of patients experienced one or more adverse events. However, all events were minor and without consequences. No serious or long-term adverse events were detected. The success rate of thoracic epidural placement was 81%. Low postoperative pain scores were observed. CONCLUSION Thoracic epidural analgesia is an extremely effective pain control technique, with a surprisingly high number of minor adverse events but safe with regard to serious adverse events. TRIAL REGISTRATION The local research ethics committee approved and registered this study on 16 May 2022 (registration number: S66594).

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Which Is More Effective for Minimally Invasive Pectus Repair: Epidural or Paravertebral Block?

Cited by 5 publications

References 20 publications

A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children

A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children

The efficacy of Erector Spinae Plane Block (ESPB) applied under ultrasonography guidance in percutaneous nephrolithotomy operations

Safety and efficacy of high thoracic epidural analgesia for chest wall surgery in young adolescents

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