Search

Background: Inadequate acute postoperative pain management is linked to the effect on the stress response and development of chronic pain. A unique regional anaesthetic method that is becoming more important for postoperative pain management is erector spinea plane block (ESP). Since its initial description, physicians have questioned weather this novel easy method can take the place of paravertebral block (PVB). Our goal was to evaluate, in contrast to control group, the effects of ESP & PVB on acute and chronic post-mastectomy pain. Methods: One hundred and five female patients undergoing modified radical mastectomy participated in this study, randomly allocated into three equal groups: erector spinae plane block (ESP), thoracic paravertebral (TPV), and control groups. Both blocks were ultrasound-guided with 20 ml 0.25% bupivacaine according to patients' group, control group was administered standard general anaesthesia without intervention. Total morphine consumption in the first 24 h postoperative was the primary outcome. The secondary outcomes were time to the first analgesia, (Visual Analogue Scale)VAS score, serum level of cortisol and prolactin, sedation score, side effects, and LANSS scores in the first, third, and sixth postoperative months were among the variables compared between groups. Results: Total morphine consumption in the first 24 h was significantly higher in control than ESP and TPV groups (10.74 ± 1.37, 8.17 ± 1.69, 5.70 ± 1.95 respectively p < 0.001). Time to first analgesic request was the shortest in control versus ESP and TPV groups as (4.37 ± 3.06, 8.13 ± 1.75, 10.64 ± 1.83 h respectively p ˂0.001). ESP and TPV had significantly lower cortisol and prolactin levels compared to control (p < 0.001). The highest LANSS scores were in the control group in the first, third, and sixth months compared with ESP and TPV, with no significant difference between ESP and TPV. Conclusion: ESP and TPV blocks provided superior early postoperative analgesia and reduced stress response compared to the control group in female patients undergoing modified radical mastectomy. PVB is better than ESB in acute postoperative pain management (the total morphine consumption VAS score and time of first analgesic request). Both techniques showed better long-term outcomes compared to the control group regarding LANSS score in the 6-month follow-up. Trial registration: https://www.ClinicalTrials.gov trial registry (identifier NCT04498234 on 04/08/2020). [ABSTRACT FROM AUTHOR]

Background: Erector spinae plane block (ESPB) is a promising technique for effective analgesia. It is still uncertain if ESPB offers the same opioid-sparing effect as thoracic paravertebral block (PVB) in midline incision for upper abdominal surgery. Methods: The study is a prospective, bi-center, randomized, controlled, non-inferior trial. One hundred fifty-eight patients scheduled for upper abdominal surgery will be randomly assigned to receive bilateral ESPB or PVB before surgery. The primary outcome will be the equivalent cumulative analgesia dosage of sufentanil during the surgery, which is defined as the total dosage of sufentanil from anesthesia induction to tracheal extubation. The main secondary outcomes include postoperative complications and the quality of recovery-15 score at 24 h, 48 h, and 30 days after surgery. Discussion: This study will assess the opioid-sparing efficacy of ESPB and PVB, complications, and the quality of recovery of two blocks. Trial registration: ChiCTR2300073030 (https://www.chictr.org.cn/). Registered on 30 June 2023. [ABSTRACT FROM AUTHOR]

Francesco Coppolino, Simona Brunetti, Leonardo Maria Bottazzo, Gianluigi Cosenza, Pasquale Sansone, Marco Fiore, Maria Beatrice Passavanti, Vincenzo Pota, Maria Caterina Pace Department of Women, Children and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, ItalyCorrespondence: Simona Brunetti, Department of Women, Children and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia N.2, Naples, 80134, Italy, Tel +393492424108, Email simona.brunetti@studenti.unicampania.itPurpose: Thoracic surgery often results in severe chronic postoperative pain. Current evidence favors two locoregional techniques. Thoracic Epidural Anesthesia (TEA), the gold standard, and Thoracic Paravertebral Block (TPVB), which is associated with fewer side effects but is limited by short duration of action of local anesthetics (LA) and potential failure due to improper drug distribution. This study investigates the use of dexmedetomidine (DEX) as adjuvant to prolong the effects of LA in TPVB, with methylene blue used for visual confirmation of accurate injectate spread.Patients and Methods: We observed 6 patients undergoing Video-Assisted Thoracoscopy (VATS) lobectomy who received TPVB with ropivacaine, DEX and methylene blue. The primary endpoint was postoperative pain recorded at 1, 12, 24, 48 hours using Numeric Rating Scale (NRS); the secondary endpoints were cumulative opioid consumption in the first 24 hours in Milligram Morphine Equivalents (MME); adverse events: occurrence of bradycardia, hypotension, Postoperative Nausea and Vomiting (PONV); length of hospital stay. All patients completed the study.Results: Our results showed optimal pain scores, with NRS scores always below 4, decreased need for opioids, and prolonged analgesia. None of the patients had bradycardia nor PONV, but two patients experienced acute and self-limited hypotension following TPVB.Conclusion: Thoracic Paravertebral Block with Dexmedetomidine and methylene blue was effective and safe in controlling postoperative pain. Methylene blue could help improving knowledge on anesthetics distribution to reduce failure rates.Keywords: locoregional anesthesia, paravertebral block, post-operative pain, thoracic surgery

Abstract Background Inadequate acute postoperative pain management is linked to the effect on the stress response and development of chronic pain. A unique regional anaesthetic method that is becoming more important for postoperative pain management is erector spinea plane block (ESP). Since its initial description, physicians have questioned weather this novel easy method can take the place of paravertebral block (PVB). Our goal was to evaluate, in contrast to control group, the effects of ESP & PVB on acute and chronic post-mastectomy pain. Methods One hundred and five female patients undergoing modified radical mastectomy participated in this study, randomly allocated into three equal groups: erector spinae plane block (ESP), thoracic paravertebral (TPV), and control groups. Both blocks were ultrasound-guided with 20 ml 0.25% bupivacaine according to patients’ group, control group was administered standard general anaesthesia without intervention. Total morphine consumption in the first 24 h postoperative was the primary outcome. The secondary outcomes were time to the first analgesia, (Visual Analogue Scale)VAS score, serum level of cortisol and prolactin, sedation score, side effects, and LANSS scores in the first, third, and sixth postoperative months were among the variables compared between groups. Results Total morphine consumption in the first 24 h was significantly higher in control than ESP and TPV groups (10.74 ± 1.37, 8.17 ± 1.69, 5.70 ± 1.95 respectively p

Abstract Background Erector spinae plane block (ESPB) is a promising technique for effective analgesia. It is still uncertain if ESPB offers the same opioid-sparing effect as thoracic paravertebral block (PVB) in midline incision for upper abdominal surgery. Methods The study is a prospective, bi-center, randomized, controlled, non-inferior trial. One hundred fifty-eight patients scheduled for upper abdominal surgery will be randomly assigned to receive bilateral ESPB or PVB before surgery. The primary outcome will be the equivalent cumulative analgesia dosage of sufentanil during the surgery, which is defined as the total dosage of sufentanil from anesthesia induction to tracheal extubation. The main secondary outcomes include postoperative complications and the quality of recovery-15 score at 24 h, 48 h, and 30 days after surgery. Discussion This study will assess the opioid-sparing efficacy of ESPB and PVB, complications, and the quality of recovery of two blocks. Trial registration ChiCTR2300073030 ( https://www.chictr.org.cn/ ). Registered on 30 June 2023.

Background and Aims: The erector spinae plane block (ESPB) is a novel regional anesthesia technique compared to the thoracic paravertebral block (TPVB) in providing postoperative pain relief in breast surgeries. Modified radical mastectomy (MRM) is a commonly performed surgery for breast cancer. The objective of the study is to compare the efficacy of ESPB and TPVB in providing postoperative pain relief after MRM. Material and Methods: This is a prospective randomized study conducted in a tertiary care teaching hospital. Sixty ASA I–III adult patients (age >18 years) scheduled to undergo elective unilateral MRM for breast cancer were enrolled in the study. Ultrasound-guided ESPB or TPVB with 0.25% bupivacaine was performed preoperatively on the patients randomized into two groups, namely, the ESPB and TPVB groups. All patients received patient-controlled analgesia for postoperative pain relief. Morphine consumption and Visual Analog Score (VAS) for pain were recorded at 3, 6, 12, and 24 h postoperatively. Results: Primarily, the mean postoperative VAS scores between the two groups at 3, 6, 12, and 24 h showed no statistical significance and were comparable when matched at different time points. However, 24-h morphine consumption was significantly more in the ESPB group (P = 0.035). Duration of block performance also showed a significant difference, with ESPB taking less time to perform (P < 0.001). The mean age and body mass index (BMI) of patients and length of hospital stay in both the groups were similar. Conclusions: Both ESPB and TPVB provided adequate analgesia in patients undergoing MRM; however, TPVB had better efficacy and opioid-sparing effect when compared to ESPB.

Background and Aims: The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. Paravertebral block (PVB) and erector-spinae block (ESPB) are two novel techniques for treating this distressing condition. We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ). Material and Methods: Sixty patients in pain due to AHZ were selected for a prospective randomized control study after approval from Institutional Ethical Committee. Written informed consent was taken. Patients were randomized and allotted into Control-group: standard treatment (oral antivirals, analgesics, neuropathic medicines); PVB-Group: standard treatment with PVB and ESPB- Group: standard treatment with ESPB. Under ultrasound guidance, both blocks were administered with 20 ml of 0.25% bupivacaine + dexamethasone 8 mg. Efficacy was evaluated on the 15th, 30th, and 60th day post treatment. The primary endpoint was the proportion of patients with adequate relief from pain and allodynia post study. Results: The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). The proportion of patients with pain relief was higher among the PVB group compared to the ESPB group but not statistically significant (p 0.749). On day 60, the mean pain score was 2.45 (±3.05) and 2.15 (±2.7) in ESPB and PVB groups, respectively, and 4.3 (±2.27) in the control group (p 0.003). Conclusion: PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN.

The objective was to analyze the literature on modern approaches to the choice of regional anesthesia method for thoracoscopic surgical interventions. Materials and methods. A review of the most common approaches to the choice of regional anesthesia method for thoracoscopic surgical interventions was carried out.Results. The analysis of the literature has shown that to date, in the practice of an anesthesiologist and intensivist, there is no single standard for anesthesia of patients during and after thoracoscopic operations, but the use of regional anesthesia methods can increase the positive effects of minimally invasive methods, which include video-assisted thoracoscopic surgeries (VATS). Further studies comparing the efficacy of regional anesthesia methods in thoracic surgery are needed.Conclusion. At the moment, the evidence collected in the world specialized literature confirms that thoracic epidural analgesia (TEA), paravertebral block, erector spinae plane block, and serratus anterior plane block can be considered comparatively effective methods of regional anesthesia in VATS. Meanwhile, high-quality comparative clinical studies that allow us to choose the most effective and safe method of regional anesthesia are limited.

Background/Objectives: The paravertebral block (PVB) is a well-studied, effective method of analgesia for breast surgery. Alternative techniques involving the blockage of intercostal nerve branches are the serratus anterior plane block (SAPB) and the erector spinae plane block (ESPB). However, no studies comparing both fascial blocks to PVB in breast surgery have been published to date. We evaluated the effectiveness of ESPB and SAPB vs. PVB, expressed as the requirement for intraoperative fentanyl, pain intensity at rest and during coughing, and morphine consumption on the first postoperative day. Additional aims were to perform an evaluation of the safety of the block types used. Materials and Methods: A total of 77 women and 1 man with stage I and II clinical breast cancer, aged 18–85 years, were randomized into one of three study groups: SAPB, PVB, and ESPB. Results: There were no statistically significant differences in fentanyl consumption during surgery with respect to the type of block used (p = 0.4246). Morphine consumption in the postoperative period was highest in the ESPB group, averaging 9.4 mg. There was a statistically significant difference in pain intensity from 4 pm on the day of surgery to 8 am the following morning. No complications related to the blocks were observed on the first postoperative day. Conclusions: Both the serratus anterior plane block and the erector spinae plane block were as effective as the paravertebral block in achieving intraoperative analgesia. The serratus anterior plane block was equally as effective as the paravertebral block in achieving postoperative analgesia. The erector spinae plane block was significantly less effective in achieving postoperative analgesia than both the paravertebral block and serratus anterior plane block. [ABSTRACT FROM AUTHOR]

Background & aim Paravertebral block (PVB) is a commonly used technique, for postoperative analgesia after modified radical mastectomy(MRM).Though many adjuvants to bupivacaine in PVB have been tried for postoperative analgesia, none has been found ideal. We have compared the duration of analgesia in PVB using adjuvant like dexmedetomidine and nalbuphine with bupivacaine after MRM. Methods Sixtyfive female patients posted for MRM were divided into two groups. Group BN received ultrasound guided PVB with 20 ml bupivacaine 0.25% with nalbuphine 10mg and Group BD received 20 ml bupivacaine 0.25% with dexmedetomidine 1 μg/kg. After confirming PVB, surgery was done under general anesthesia in all patients. Time for 1st rescue analgesic request was the primary aim of our study. Secondary aim of our study was numerical rating scores (NRS) for pain at rest and on movement and total analgesic consumption. Side effects like nausea and vomiting,hemodynamics and sedation in post operative 24 hrs were also assessed. Results The time of the first rescue analgesic requirement was prolonged in the group BD (7.32 ± 1.75 hours) in contrary to group BN (4.94 ± 2.12 hours). The mean total paracetamol consumption as rescue analgesia in the in the first 24 hours postoperatively was significantly reduced in group BD (2.7 ±0.94 gm) in contrary to group BN (3.6 ± 0.98 gm). (p<0.001) Decrease in hear rate and mean arterial pressure was more in BD group compared to BN group intraoperatively. (p<0.001) Conclusion Dexmedetomidine provides prolonged analgesia when used as additive to bupivacaine in PVB for modified radical mastectomy compared to nalbuphine. [ABSTRACT FROM AUTHOR]

Background and Aims: The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. Paravertebral block (PVB) and erector-spinae block (ESPB) are two novel techniques for treating this distressing condition. We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ). Material and Methods: Sixty patients in pain due to AHZ were selected for a prospective randomized control study after approval from Institutional Ethical Committee. Written informed consent was taken. Patients were randomized and allotted into Control-group: standard treatment (oral antivirals, analgesics, neuropathic medicines); PVB-Group: standard treatment with PVB and ESPB- Group: standard treatment with ESPB. Under ultrasound guidance, both blocks were administered with 20 ml of 0.25% bupivacaine + dexamethasone 8 mg. Efficacy was evaluated on the 15th, 30th, and 60th day post treatment. The primary endpoint was the proportion of patients with adequate relief from pain and allodynia post study. Results: The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). The proportion of patients with pain relief was higher among the PVB group compared to the ESPB group but not statistically significant (p 0.749). On day 60, the mean pain score was 2.45 (±3.05) and 2.15 (±2.7) in ESPB and PVB groups, respectively, and 4.3 (±2.27) in the control group (p 0.003). Conclusion: PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN. [ABSTRACT FROM AUTHOR]

Background and Aims: The erector spinae plane block (ESPB) is a novel regional anesthesia technique compared to the thoracic paravertebral block (TPVB) in providing postoperative pain relief in breast surgeries. Modified radical mastectomy (MRM) is a commonly performed surgery for breast cancer. The objective of the study is to compare the efficacy of ESPB and TPVB in providing postoperative pain relief after MRM. Material and Methods: This is a prospective randomized study conducted in a tertiary care teaching hospital. Sixty ASA I–III adult patients (age >18 years) scheduled to undergo elective unilateral MRM for breast cancer were enrolled in the study. Ultrasound-guided ESPB or TPVB with 0.25% bupivacaine was performed preoperatively on the patients randomized into two groups, namely, the ESPB and TPVB groups. All patients received patient-controlled analgesia for postoperative pain relief. Morphine consumption and Visual Analog Score (VAS) for pain were recorded at 3, 6, 12, and 24 h postoperatively. Results: Primarily, the mean postoperative VAS scores between the two groups at 3, 6, 12, and 24 h showed no statistical significance and were comparable when matched at different time points. However, 24-h morphine consumption was significantly more in the ESPB group (P = 0.035). Duration of block performance also showed a significant difference, with ESPB taking less time to perform (P < 0.001). The mean age and body mass index (BMI) of patients and length of hospital stay in both the groups were similar. Conclusions: Both ESPB and TPVB provided adequate analgesia in patients undergoing MRM; however, TPVB had better efficacy and opioid-sparing effect when compared to ESPB. [ABSTRACT FROM AUTHOR]

Purpose: To compare the impact of erector spinae plane block (ESPB) and paravertebral block (PVB) on the quality of postoperative recovery (QoR) of patients following laparoscopic sleeve gastrectomy (LSG). Methods: A total of 110 patients who underwent elective LSG under general anesthesia were randomly assigned to receive either ultrasound-guided bilateral ESPB or PVB at T8 levels. Before anesthesia induction, 40 mL of 0.33% ropivacaine was administered. The primary outcome was the QoR-15 score at 24 hours postoperatively. Results: At 24 hours postoperatively, the QoR-15 score was comparable between the ESPB and PVB groups (131 (112–140) vs. 124 (111–142.5), P = 0.525). Consistently, there was no significant difference in QoR-15 scores at 48 hours postoperatively, numerical rating scale (NRS) pain scores at any postoperative time points, time to first ambulation, time to first anal exhaust, postoperative cumulative oxycodone consumption, and incidence of postoperative nausea and vomiting (PONV) between the two groups (all P > 0.05). No nerve block-related complications were observed in either group. Conclusion: In patients undergoing LSG, preoperative bilateral ultrasound-guided ESPB yields comparable postoperative recovery to preoperative bilateral ultrasound-guided PVB. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Serratus anterior plane block (SAPB) and paravertebral block (PVB) are well known to reduce pain levels after video-assisted thoracoscopic surgery (VATS). However, the relative efficacies of each block and a combination of the 2 have not been fully characterized. The objective of the present study was to assess the efficacy of PVB alone, SAPB alone and the combination of PVB and SAPB with regard to the occurrence and intensity of pain after VATS. METHODS We conducted the THORACOSOPIC single-centre, double-blind, randomized trial in adult patients due to undergo elective VATS lung resection. The participants were randomized to PVB only, SAPB only and PVB + SAPB groups. The primary end-point was pain on coughing on admission to the postanaesthesia care unit. The secondary end-points were postoperative pain at rest and on coughing at other time points and the cumulative opioid consumption. Pain was scored on a visual analogue scale. RESULTS One-hundred and fifty-six patients (52 in each group) were included. On admission to the postanaesthesia care unit, the 3 groups did not differ significantly with regard to the pain on coughing: the visual analogue scale score was 3 (0–6), 4 (0–8) and 2 (0–6) in the PVB, SAPB and PVB + SAPB groups, respectively (P  =   0.204). During postoperative care, the overall pain score was significantly lower in the SABP + PVP group at rest and on cough. CONCLUSIONS The combination of SABP + PVB could be beneficial for pain management in VATS in comparison to SABP or PVB alone. [ABSTRACT FROM AUTHOR]

Background Perioperative thoracic epidural analgesia (TEA) is commonly used in hepatectomy patients since it is opioid-sparing. However, TEA has a high failure rate and is associated with potentially devastating complications (spinal haematoma) and the risk is increased with hepatectomy. Thus, some centres favour systemic opioid-based modalities which, in turn, are associated with inferior analgesia and well-known risks/side-effects. Hence, alternative analgesic methods are desirable. Paravertebral block (PVB) has been used in liver resection with advantages including haemodynamic stability, low failure rates, and low risk of spinal haematoma. The purpose of this pilot RCT is to compare continuous TEA (traditional standard of care is local anesthetic (LA) + opioids) with PVB (traditional standard of care is with LA without opioid) for patients undergoing hepatectomy. We hypothesise that pain outcomes will be comparable between groups, but PVB patients will require fewer perioperative vasopressors/blood products, have fewer opioid-related side effects and a shorter hospital length of stay. Methods With ethics approval, this non-inferiority, pilot RCT with a convenience sample of 50 hepatectomy patients will examine whether PVB imparts analgesia comparable to TEA but with fewer adverse effects. Primary outcomes are surrogates of analgesia for 72 h postoperatively (i.e., opioid consumption, time to first analgesic request and pain scores at rest and with coughing); Secondary outcomes are blood products/fluids administered; side effects/complications until 72 h postoperatively; length of hospital stay. The results will be used to plan a large multicentre trial comparing TEA vs. PVB in hepatectomy patients. This study has a high potential to positively impact the quality/safety of patient care. ClinicalTrials.gov registration NCT02909322 (09-21-2016); Available at URL: https://clinicaltrials.gov/ct2/show/NCT0290932

Background Perioperative thoracic epidural analgesia (TEA) is commonly used in hepatectomy patients since it is opioid-sparing and reduces cardiorespiratory complications. However, TEA has a high failure rate and is associated with potentially devastating complications (particularly spinal haematoma) and the risk is increased with hepatectomy. Thus, some centres favour systemic opioid-based modalities which, in turn, are associated with inferior analgesia and well-known risks/side-effects. Hence, alternative analgesic methods are desirable. Paravertebral block (PVB) has been used in liver resection with advantages including haemodynamic stability, low failure rates, and low risk of spinal haematoma. Our purpose is to conduct a blinded, pilot RCT with hepatectomy patients randomised to receive TEA or PVB for perioperative analgesia. We hypothesise that opioid consumption, time to first analgesic request, and pain scores will be comparable between groups, but PVB patients will require fewer perioperative vasopressors/blood products, and have fewer adverse events and a shorter hospital stay. Methods With ethics approval, this non-inferiority, pilot RCT with a convenience sample of 50 hepatectomy patients will examine whether PVB imparts analgesia comparable to TEA but with fewer adverse effects. Primary outcomes are surrogates of analgesia for 72 h postoperatively (i.e., opioid consumption, time to first analgesic request and pain scores at rest and with coughing); Secondary outcomes are blood products/fluids administered; side effects/complications until 72 h postoperatively; length of hospital stay. The results will be used to plan a large multicentre trial comparing TEA vs. PVB in hepatectomy patients. This study has a high potential to positively impact the quality/safety of patient care. ClinicalTrials.gov registration NCT02909322 (09-21-2016); Available at URL: https://clinicaltrials.gov/ct2/show/NCT0290932

Objectives: This study aimed to compare the efficacy of epidural catheter and paravertebral block methods for the management of postoperative pain in patients undergoing thoracotomy and pneumonectomy and to develop clinical routines for optimal pain control. Methods: Hemodynamic data, arterial blood gas values, VAS scores (at ICU admission and postoperative 8, 16, and 24 h), total amount of rescue analgesics for 24 h, and mortality rates of patients undergoing pneumonectomy treated with preoperative thoracic epidural analgesia (TEA) and paravertebral block were compared. Results: Patients’ pain scores upon admission to the ICU and 8, 16, and 24 h postoperatively and the total amount of rescue analgesia administered during the study period were compared. VAS scores 8 and 16 h postoperatively were statistically similar between the groups. Additionally, postoperative ICU admission and 24-h VAS follow-up were significantly lower in the TEA group (p<0.05). The mean total dose (mg) of additional morphine at 24 h in PVB group was found to be statistically significantly higher than that in the TEA group (p=0.0001). Conclusion: The data of 2,422 operations were analyzed, and 34 patients were included in this study. No statistically significant difference was observed between the groups in terms of mortality. In this study, we observed that postthoracotomy pain can be managed by paravertebral block with preoperative bolus bupivacaine. This study confirmed that paravertebral block is an effective method for achieving analgesia during pneumectomy, as recommended by the PROSPECT guidelines. [ABSTRACT FROM AUTHOR]

Background: Pain associated with traumatic multiple fracture ribs is usually severe, difficult to control, frequently alters pulmonary mechanics, and may even limit movement ability. Thoracic epidural and paravertebral blocks (PVB) have traditionally been employed but they are technically complex, are associated with adverse effects and are often not feasible in the presence of conditions such as coagulopathy, hemo-dynamic instability and vertebral fractures. ESPB is a simple block in terms of easy identification of landmarks with ultrasound and safe block with no neurovascular structures in the ESP. Hence the current study was undertaken to assess clinical utility of this block (ESPB) in comparison with paravertebral blocks (PVB) for pain relief in multiple rib fractures. Methodology: A prospective, randomized, double-blinded study was conducted in 100 adult patients with traumatic multiple rib fractures, during April 2020 to February 2023 after obtaining institutional ethical committee approval. ESPB and PBV was performed under ultrasound guidance. Haemodynamic changes, opioid consumption, time to recue analgesia and VAS scores in both the groups were recorded. Statistical analysis done using independent sample T test when data was normally distributed and Mann whitney U test for skewed distribution with outliers with P<0.05 as statistically significant. SPSS version 20 was the statistical software used. Results: Mean of HR and MAP showed no significant difference in both the groups. Mean and SD of fentanyl consumption in patients of group PVB (176.87± 27.5 microgram) was more which was statistically significant when compared to group ESPB (134.9± 35.8 microgram). VAS static and dynamic showed no significant difference in both the groups when measured periodically in the first 48 hours. Conclusions: In conclusion, ESPB and PVB blocks in multiple rib fractures are effective methods for pain relief with similar haemodynamic effects. ESPB has the advantage of significant decrease in fentanyl consumption and increased time to rescue analgesia compared to PVB. [ABSTRACT FROM AUTHOR]

Introduction: Zoster-associated pain (ZAP) treatment and management is still inadequate. Repeated intervention protocol is often applied to manage ZAP. This study aimed to retrospectively investigate the effect of repeated applications of pulsed radiofrequency therapy on controlling acute/subacute ZAP. Methods: From March 2019 to December 2021, 150 patients with acute/subacute ZAP who underwent repeated application of pulsed radiofrequency treatment (R-PRF) and pulsed radiofrequency combined paravertebral block interventions (PRF + PVB) in the Pain Department of the affiliated Hospital of Jiaxing University were enrolled. Patients were grouped by intervention protocol and received at least 12 months of follow-up assessments using the Numerical Rating Scale score (NRSs), Pittsburg Sleep Quality Index (PSQI), Simple McGill Pain Questionnaire-2 score (SF-MPQ-2s), and follow-up interventions. Results: Both groups experienced a reduction in the incidence of clinically meaningful ZAP after the intervention therapy. In the R-PRF group, there were 36 cases of clinically meaningful ZAP within the first month post-treatment, while the PRF + PVB group had 38 cases. The incidence of clinically meaningful ZAP, as determined by multivariable generalized estimating equations, was 42.86% in the R-PRF group and 57.58% in the PRF + PVB group during the first month of follow-up. There was a significant difference in the incidence of clinically meaningful ZAP between the two groups after 1 month of treatment (adjusted odds ratio: 0.40; 95% confidence interval: 0.18–0.91; p = 0.03). Conclusions: Both R-PRF and PRF + PVB treatments effectively relieve pain in patients with acute/subacute ZAP. However, R-PRF may have superior efficacy compared to PRF + PVB in reducing the incidence of clinically meaningful ZAP 1 month after treatment. [ABSTRACT FROM AUTHOR]

Background: Pain management plays an essential role in postoperative recovery after lung surgeries. The Erector Spinae Plane Block (ESPB) is a widely used regional anaesthesia technique; however, few clinical trials have compared this block to active control in thoracic surgeries. This study evaluated the non‐inferiority of the analgesia provided by ESPB when compared to paravertebral block (PVB) in lung surgeries. Methods: Randomised, active‐controlled, blinded for patients and assessors, non‐inferiority trial. Patients who underwent unilateral lung surgeries were divided into two groups according to the regional anaesthesia technique—continuous ESPB or PVB at the T5 level. The primary outcome was to assess pain using a numerical rating scale (NRS) with a test of the interaction of three measures over 24 h postoperatively. An NRS score ≥ 7 was considered analgesia failure, and the prespecified non‐inferiority margin was 10%. Results: In the interim analysis that terminated this study, 120 participants were enrolled. ESPB patients reported higher mean NRS general values over 24 h, 4.6 ± 3.2 in the ESPB group versus 3.9 ± 2.9 in the PVB group, with a difference of −0.67 (−15.2%) and 95%CI: −1.29 to −0.05 (p =.02), demonstrating not non‐inferiority. In addition, the ESPB group presented higher NRS failure of analgesia over 24 h (p <.01) and required more postoperative opioids (p =.01 over 24 h). There was no difference in patient satisfaction between groups. Conclusion: This trial demonstrated that a continuous erector spinae plane block was not non‐inferior to a continuous paravertebral block for analgesia after lung surgery but resulted in higher levels of postoperative pain and opioid consumption. [ABSTRACT FROM AUTHOR]

Purpose To compare the impact of erector spinae plane block (ESPB) and paravertebral block (PVB) on the quality of postoperative recovery (QoR) of patients following laparoscopic sleeve gastrectomy (LSG). Methods A total of 110 patients who underwent elective LSG under general anesthesia were randomly assigned to receive either ultrasound-guided bilateral ESPB or PVB at T8 levels. Before anesthesia induction, 40 mL of 0.33% ropivacaine was administered. The primary outcome was the QoR-15 score at 24 hours postoperatively. Results At 24 hours postoperatively, the QoR-15 score was comparable between the ESPB and PVB groups (131 (112–140) vs. 124 (111–142.5), P = 0.525). Consistently, there was no significant difference in QoR-15 scores at 48 hours postoperatively, numerical rating scale (NRS) pain scores at any postoperative time points, time to first ambulation, time to first anal exhaust, postoperative cumulative oxycodone consumption, and incidence of postoperative nausea and vomiting (PONV) between the two groups (all P > 0.05). No nerve block-related complications were observed in either group. Conclusion In patients undergoing LSG, preoperative bilateral ultrasound-guided ESPB yields comparable postoperative recovery to preoperative bilateral ultrasound-guided PVB.

Background: Effective postoperative analgesia enhances the patient's comfort and facilitates early mobilization and recovery., Objective: This study compared the analgesic efficacy of the erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), and quadratus lumborum block (QLB) for pelvi-ureteric surgeries. The primary outcome measure in the study was the total morphine consumption during the first 48 hours following the operation. The secondary outcomes included the levels of postoperative pain, the time of first rescue analgesia, and the satisfaction of patients., Study Design: Randomized double-blind noninferiority trial., Setting: Kafr Elsheikh University Hospitals, Egypt., Methods: This trial was performed on 90 patients between the ages of 21 and 65, men and women, who had an American Society of Anesthesiologists physical status of I or II and were undergoing elective pelvi-ureteric surgeries. Patients were assigned equally to the TPVB, QLB, and ESPB groups. Before the induction of general anesthesia, blocks were performed using 20 mL of 0.25% bupivacaine. The numeric rating scale (NRS) score was measured in the post-anesthesia care unit at one, 2, 4, 6, 8, 12, 24, 36, and 48 hours. If the NRS score was ≥ 4, the patient received 3 mg of intravenous morphine., Results: The time of the performing block was shorter in the ESPB group than in the TPVB or QLB group (P < 0.001), but the TPVB and QLB groups were comparable. The intraoperative consumption of fentanyl and total consumption of morphine at 24 and then 48 hours postoperatively were comparable among the 3 groups, as were the satisfaction of the patient, NRS scores, time of first rescue analgesia, and complications (P > 0.05)., Limitations: A relatively small sample size, a single-center setting, and the absence of a control group., Conclusions: In pelvi-ureteric surgeries, the ESPB, TPVB, and QLB provided comparable intraoperative and postoperative analgesia, patient satisfaction, and postoperative complications, but the ESPB was performed more quickly. Therefore, we recommend the ESPB as a routine regional anesthetic technique.

Objective: To compare the effects of unilateral thoracic paravertebal block with lidocaine on hemodynamic and the level of consciousness during double lumen endotracheal intubation., Methods: From June to october 2021, a total of 40 patients American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, aged 19-65 years, scheduled for elective thoracic sugeries in Peking University International Hospital block with under general anesthesia requiring orotracheal intubation were recruited and divided into two groups: The double-lumen endobronchial intubation (group C) and double-lumen endobronchial intubation after thoracic paravertebal block with lidocaine (group P). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy, respectively. Invasive blood pressure (BP) and heart rate (HR) were recorded before and after anesthetic induction, immediately after intubation and 5 min after intubation with 1-minute interval and the intubation time was also noted. Rate-pressure product (RPP) were calculated., Results: After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. As comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BP, HR and RPP. Diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1-minute in group C compared with the baseline values. Systolic blood pressure (SBP) was not significant change and DBP increased significantly immediately after intubation in group P.HR of both groups after intubation were significantly higher than their baseline values and lasted for 4 min in group C, HR increased significantly immediately after intubation in group P. SBP, DBP, MAP, HR and RPP after intubation in group P were significantly lower than those of group C during the observation period. The value of BIS was similar between the two groups. Compared with group C, the incidence of SBP greater than 30% and RPP greater than 22 000 was significantly lower in group P in the observation period, and no patient in group P developed RPP greater than 22 000. At the end of the incidence of SBP less than 30% of the basal value and HR less than 30% of the baseline, no severe bradycardia occurred in both groups., Conclusion: During double-lumen endobronchial intubation, unilateral thoracic paravertebal block with lidocaine can provide less hemodynamic response and level of conscionsness.

Background: The inappropriate management of pain after thoracotomy results in serious complications. Several adjuvants have been added to the thoracic paravertebral block (TPVB) to enhance its effects. This work aimed to evaluate the effect of adding ketamine to TPVB on thoracotomy-related acute and chronic pain., Methods: This randomized controlled double-blinded trial included 60 patients scheduled for open thoracotomy. Patients were equally randomized into 2 groups: group K: received TPVB + 1 mL ketamine (50 mg). Group C (n = 30): received TPVB (19 mL of 0.5% levobupivacaine + 1 mL normal saline) as a control arm., Results: Group K exhibited a significant delay in requesting analgesia, required less morphine in the first 24 and 48 hours, and reported lower numerical rating scale at rest and at deep breathing at various time points compared with the control group. However, both groups were comparable in post-thoracotomy pain syndrome and the incidence of complications at 2 months and 3 months., Conclusions: Adding ketamine to TPVB resulted in better analgesia as demonstrated by significantly delayed time to first rescue analgesia, lower total amount of consumed opioid, and pain score without considerable effect on chronic pain and complications in patients undergoing thoracotomy., Competing Interests: The authors have no conflicts of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)

Background: In daily surgical practice, inguinal hernioplasty is a frequent procedure that is frequently accompanied by severe postoperative pain. Multiple regional blocks have been described for analgesia after such operations. Retrolaminar block (RLB) is a paravertebral block (PVB) variant that provides excellent analgesia and reduces the risk of complications. This prospective trial compared the analgesic efficacy of PVB and RLB in the inguinal hernioplasty., Methods: The 56 patients included were randomly assigned into two equal groups according to the block performed under ultrasound guidance at the T12 level: PVB group (28 patients) and RLB (28 patients). Time until the first rescue analgesia was our primary outcome. Other outcomes included the time to perform the block, changes in intraoperative hemodynamic parameters, postoperative VAS, 24-h morphine consumption, the level of patient satisfaction, and the incidence of block-related complications., Results: Demographic data were comparable in the two groups. However, the time needed for the block was significantly shortened with the RLB (p < 0.001). Patients in the PVB groups expressed better pain scores and lower opioid consumption. Additionally, the time to the first call for opioid analgesia showed a significant prolongation in association with the PVB. There was no discernible difference in the frequency of adverse events and recorded MAP and HR., Conclusion: The PVB has a superior perioperative analgesic profile compared to the RLB, which manifested in the prolonged duration to the first rescue analgesics, better pain scores, and less opioid consumption, with no significant increase in block-related complications., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Proximal femur fracture surgeries have become increasingly prevalent, presenting unique challenges for postoperative pain management due to patient demographics and comorbidities. Erector spinae plane block (ESPB) has emerged as a relatively safe alternative to paravertebral block (PVB). Our aim was to compare ultrasound-guided continuous ESPB with continuous PVB for postoperative analgesia in patients undergoing proximal femur surgeries under spinal anesthesia., Methods: A prospective randomized interventional study was conducted on 60 patients between 18 and 60 years of age undergoing proximal femur surgeries under spinal anesthesia with American Society of Anesthesiologists physical status I and II between January 2019 and April 2020. Patients were randomly assigned to receive either ultrasound-guided continuous ESPB (Group E, n = 30) or ultrasound-guided continuous PVB (Group P, n = 30) using a computer-generated randomization table. The mean maximum visual analog scale (VAS) score, VAS score in the first 24 h, the time of rescue analgesia, and total requirement of rescue analgesia were assessed., Results: The maximum VAS score within the first 24 h was numerically higher in Group P but statistically insignificant ( p -value 0.279). VAS scores at 0, 1, 2, 6, and 18 h postoperatively were comparable in both groups. However, at the 24-h mark, the VAS score between Group E and Group P was statistically significant ( p -value 0.018) but not clinically relevant. The mean paracetamol and tramadol requirements were comparable between the two groups., Conclusion: Continuous ESPB is as effective as continuous PVB for postoperative analgesia in proximal femur surgeries. The enhanced safety profile of erector spinae block underscores its significance in postoperative pain management., (© 2024 the author(s), published by De Gruyter.)

The efficacy of the erector spinae plane block (ESPB) has been demonstrated in several meta-analyses and it is increasingly being used in clinical practice. However, its mechanism of action is still not fully elucidated. Although initial anatomical studies have suggested the spread of the injectate into the paravertebral space as the main mechanism of action, more recent studies have not consistently demonstrated this. This systematic review was conducted to determine the overall proportion and extent of injectate spread following a thoracic ESPB. PubMed, Scopus and EMBASE were searched. All studies that examined the injectate spread after a thoracic ESPB either through dissection or imaging were included. Excluded were all reviews, studies performed in paediatric patients and non-thoracic ESPBs. The primary outcome was the proportion of subjects with injectate spread in the erector spinae plane (ESP), paravertebral space (PVS), intercostal space (ICS) and epidural space (ES). This review included 29 studies involving 113 cadavers and 79 volunteers. The proportion of subjects with injectate spread in the ESP, ICS, ES and PVS was 1 (95% confidence interval, 0.97–1), 0.51 (95% CI, 0.38–0.64), 0.38 (95% CI, 0.28–0.5) and 0.57 (95% CI, 0.49–0.64) respectively. The mean spread of injectate in the ESP, ICS, ES and PVS were 9.1 (95% CI, 8.0–10.3), 5.6 (95% CI, 4.0–7.3), 3.1 (95% CI, 1.0–5.3) and 3.5 (95% CI, 2.4–4.6) spinal levels respectively. Based on this study, the thoracic ESPB consistently led to injectate spread into the ESP compartment but less reliable spread into the PVS, ES and ICS compartments. There is also preliminary evidence that an increased time to assessment may be associated with an increased spread of injectate into the PVS. • Consistent with other literature, this study shows that the likely mechanism of action of the Erector Spinae Plane block is via diffusion or bulk flow to the paravertebral space, epidural space and intercostal space. • However, the spread into these areas is inconsistent, raising questions about the reliability of the block. • Further research is required to understand the relationship between injectate volume, timing of assessment and injectate spread. [ABSTRACT FROM AUTHOR]

Background: Transarterial chemoembolization (TACE) combined with microwave ablation (MWA) is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis. However, it may cause severe postoperative pain and inflammatory responses. The paravertebral block (PVB) is a regional anesthetic technique that provides analgesia to the thoracic and abdominal regions., Aim: To evaluate the effect of PVB on postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis., Methods: Sixty patients were randomly divided into PVB and control groups. The PVB group received ultrasound-guided PVB with 0.375% ropivacaine preoperatively, whereas the control group received intravenous analgesia with sufentanil. The primary outcome was the visual analog scale (VAS) score for pain at 6 h, 12 h, 24 h, and 48 h after the procedure. Secondary outcomes were the dose of sufentanil used, incidence of adverse events, and levels of inflammatory markers (white blood cell count, neutrophil percentage, C-reactive protein, and procalcitonin) before and after the procedure., Results: The PVB group had significantly lower VAS scores at 6 h, 12 h, 24 h, and 48 h after the procedure compared with the control group ( P < 0.05). The PVB group also had a significantly lower consumption of sufentanil and a lower incidence of nausea, vomiting, and respiratory depression than did the control group ( P < 0.05). Compared with the control group, the PVB group had significantly lower levels of inflammatory markers 24 h and 48 h after the procedure ( P < 0.05)., Conclusion: PVB can effectively reduce postoperative pain and inflammatory responses and improve postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA., Competing Interests: Conflict-of-interest statement: All authors declare that there is no disclosure of interest relationship., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)