Are single‐injection erector spinae plane block and multiple‐injection costotransverse block equivalent to thoracic paravertebral block? (original) (raw)
Related papers
Cureus, 2021
Background The 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). Methods From 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 The same needle was withdrawn from the paravertebral space and advanced into the interfascial plane above the transverse process and below the erector spinae muscle at the T5 level.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. Results The 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. Conclusıons As 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.
BMC Anesthesiology
Background Erector spinae plane block (ESPB) is a thoracic wall block that has been used frequently in recent years. It was aimed to compare the analgesic efficacy of bupivacaine in different volumes for ESPB in patients undergoing thoracotomy. Methods Patients who were in the age range of 18 to 65 years, ASA I–III, had a body mass index (BMI) of 18–30 kg/m2 and were undergoing thoracotomy were included in the study. Patients were assigned to ESPB with 30 ml 0.25% bupivacaine (Group-1) or ESPB with 20 ml 0.25% bupivacaine (Group-2) groups according to the analgesia protocol. In the postoperative care unit, intravenous morphine was administered via a patient-controlled analgesia pump for 24 h. A paracetamol dose of 1 g every 8 h and a dexketoprofen dose of 50 mg twice daily were administered iv for multimodal analgesia. Results Visual analog scale (VAS) resting scores, the 1st (p = 0.001), 2nd (< 0.001), 4th (< 0.001), 8th (< 0.001), 16th (< 0.010), 24th (< 0.044), and...
Erector Spinae Plane (ESP) Block: a New Paradigm in Regional Anesthesia and Analgesia
Current Anesthesiology Reports, 2019
Purpose of Review The erector spinae plane (ESP) block is an ultrasound-guided regional anesthesia technique that has enjoyed unprecedented popularity since its description in 2016. This review summarizes the applied anatomy, technical performance, and clinical application of the ESP block. Recent Findings Dissection and imaging studies indicate that paravertebral local anesthetic spread is a primary mechanism of action of the ESP block. A large volume of case report literature supports its efficacy in myriad clinical settings, including thoracic surgery, thoracic trauma, cardiac surgery, abdominal surgery, spine surgery, and painful conditions of the upper and lower limbs. Several randomized controlled trials have also been published that report significant analgesic benefit compared with systemic analgesia alone. Summary The ESP block is a highly effective and versatile technique for the management of acute and chronic pain. Further studies are needed to definitively determine its efficacy compared with more established techniques. Keywords Erector spinae plane block. Paraspinal block. Fascial plane block. Regional anesthesia. Regional analgesia. Multimodal analgesia This article is part of the Topical Collection on Regional Anesthesia * Ki Jinn Chin
Is Paravertebral Block More Effective in Thoracotomy Patients Compared to Thoracic Epidural Block?
Journal of Pain & Relief, 2018
Purpose: Paravertebral block (PVB) is a simple and safe technique that can be more efficacious than epidural block (EPB) in controlling postoperative pain. We aimed to confirm this by comparing the two methods in patients after thoracotomy. Methods: Patients were randomly divided into two groups, PVB or EPB (n=30 in each). Vital signs and the visual analog scale (VAS) were evaluated before giving the block then 30 minutes and 3, 6, 9 and 12 hours after thoracotomy. Complications and need for additional analgesic agents were also scrutinized. Results: The most significant finding was better preservation of pulmonary function tests at most time points in the PVB group (<0.05). VAS scores trended to be better in the PVB group, but the difference was significant only at 30 minutes after giving the block. There were no significant differences between the groups in the incidence of complications or the need for additional analgesic agents. Conclusion: Paravertebral and epidural blocks are effective in a similar degree in controlling post-operative pain but paravertebral block is safer and more tolerable for the patients.
Hamidiye Medical Journal, 2023
Background: Severe postoperative pain may occur following thoracotomy. The sources of this pain often include multiple muscle incisions, chest drains and possible rib injury. The management of this pain is extremely important for rehabilitation in the postoperative period. Thoracic epidural analgesia (TEA) represents the "gold standard" of pain control. However, this approach has serious problems such as hypotension, urinary retention, and hematoma. The erector spinae plane block (ESPB) is a novel regional analgesia technique and it is a simple, safe and effective method that can be applied as an alternative. The aim of this study was to assess the analgesic effectiveness of the ESPB and TEA techniques after thoracotomy. Materials and Methods: This retrospective, single-center study conducted between October 2018 and September 2020. We evaluated 83 patients who received ESPB, TEA and conventional (non-regional) technique. Demographic data, operation type and duration, postoperative visual analog scale (VAS) scores, opioid consumption were obtained from anesthesia and clinical patient follow-up forms. Results: The study included 83 patients who underwent thoracotomy and were divided into three groups as group ESPB (28), group TEA (33) and group control (22) who did not apply any regional analgesia method. The VAS scores at the 8 th , 24 th and 48 th hours postoperatively, were found to be significantly lower in the ESPB and TEA groups compared to the control group (p<0.05). ESPB and TEA groups had similar levels of VAS scores and opioid consumption (p>0.05). Opioid consumptions of ESPB and TEA groups was significantly lower than that in the control group (p<0.05). Conclusion: ESPB, which provides a similar level of analgesia with TEA in the management of postoperative analgesia in thoracotomy, can be considered a good alternative regional analgesia technique especially in patients with additional comorbidities such as obesity and spinal deformity.
Anestezi dergisi, 2020
Objective: Evaluation of the effectiveness of ultrasound (US)-guided erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) compared to no intervention control group for postoperative pain management in video assisted thoracic surgery (VATS) patients. Method: Three groups-Group ESPB, Group TPVB and the control group (n=30 per group) were included in this prospective, randomized, controlled study. The US-guided blocks were performed preoperatively in the ESPB and TPVB groups. Intravenous patient-controlled postoperative analgesia via fentanyl was administered in all of the patients. The patients were evaluated using visual analogue scale (VAS) scores, opioid consumption, and adverse events. Results: At all time intervals fentanyl consumption and VAS scores were significantly lower both in ESPB and TPVB groups compared to the control group (p<0.001). Block procedure time was significantly lower and success of one time puncture was higher in Group ESPB as compared with that in Group TPVB (p<0.001). Conclusion: ESPB and TPVB provide more effective analgesia compared to control group in patients who underwent video-assisted thoracic surgery. ESPB had a shorter procedural time and higher success of single-shot technique compared to TPVB.
Place of the paravertebral block in post-operative analgesia in thoracic surgery
E3S Web of Conferences
The thoracic epidural analgesia (TEA) remains the standard gold for analgesic support in thoracic surgery, there is an interesting alternative to epidural analgesia, which is the paravertebral block (PVB). The aim in our study was to assess the value of performing a PVB in the management of postoperative pain in thoracic surgery compared to TEA. Methods: 80 patients were randomized to receive either epidural analgesia (n = 38, 10 cc bupivacaine 0.5% + 10 ϒ Sufentanyl then 10 cc Bupivacain 0.1% + 10 ϒ Sufentanyl via a PCA device) or PVB analgesia loss of resistance technique (n = 40, 10 cc bupivacaine 0.5% + 10 ϒ Sufentanyl via a PCA device). All patients received standard general anesthesia. The peri-operative parameters studied include standard measurement, EVA scale at rest and mobilization, use of morphinics. Results: there is a significant difference between the two groups and the incidents of puncture were significantly more important for the APDT group. The postoperative pain ...