Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective Study
Abstract Introduction Thoracic paravertebral block (TPVB) and subcostal transverse abdominis plane block (TAP) have been considered to provide an effective analgesic effect for laparoscopic and thoracoscopic surgery, respectively. The purpose of this randomized, controlled, and prospective study was...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Adis, Springer Healthcare
2023-01-01
|
| Series: | Pain and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40122-023-00474-5 |
| _version_ | 1797860021768290304 |
|---|---|
| author | Mei Xu Yuerou Feng Xiong Song Shuwen Fu XiaoFan Lu Jielan Lai Yali Lu Xudong Wang Renchun Lai |
| author_facet | Mei Xu Yuerou Feng Xiong Song Shuwen Fu XiaoFan Lu Jielan Lai Yali Lu Xudong Wang Renchun Lai |
| author_sort | Mei Xu |
| collection | DOAJ |
| description | Abstract Introduction Thoracic paravertebral block (TPVB) and subcostal transverse abdominis plane block (TAP) have been considered to provide an effective analgesic effect for laparoscopic and thoracoscopic surgery, respectively. The purpose of this randomized, controlled, and prospective study was to evaluate the analgesic effect of TPVB combined with TAP in patients undergoing total minimally invasive Mckeown esophagectomy. Methods Between February 2020 and December 2021, a total of 168 esophageal cancer patients undergoing McKeown esophagectomy at the Cancer Center of Sun Yat-Sen University, China, were randomly assigned to receive patient-controlled epidural analgesia alone (group PCEA, n = 56), patient-controlled intravenous analgesia alone (group PCIA, n = 56), and TPVB combined with TAP and patient-controlled intravenous analgesia (group PVB, n = 56). The primary outcome was a visual analogue scale (VAS) pain score on movement 48 h postoperatively. Secondary endpoints were pain scores at other points, intervention-related side effects, surgical complications, and length of intensive care unit and hospital stay. For the VAS pain score, the Kruskal–Wallis method was conducted for comparison of 3 treatment groups and further pairwise comparison with Bonferroni correction. Results On movement, the VAS in the PVB group was higher than that in the PCEA group at 48 h, 72 h, 96 h, and 120 h postoperatively (p < 0.05) except in the postoperative anesthesia care unit (PACU) and 24 h postoperatively. The VAS in the PCIA group was higher than the PCEA and PVB groups in the first 4 days after surgery. The pulmonary complication rate in the PCIA group was significantly higher than the rate in the PCEA [95% Confidence Interval 0.214 (0.354, 0.067), p = 0.024]. Conclusions Combined TPVB and TAP was more effective than intravenous opioid analgesia alone, while PCEA was more effective than TPVB combined with TAP and intravenous opioid analgesia for patients after McKeown esophagectomy. Trial Registration Chinese Clinical Trial Registry; ChiCTR2000029588. |
| first_indexed | 2024-04-09T21:38:59Z |
| format | Article |
| id | doaj.art-64f7c96bbce545b9b1436633e495d64f |
| institution | Directory Open Access Journal |
| issn | 2193-8237 2193-651X |
| language | English |
| last_indexed | 2024-04-09T21:38:59Z |
| publishDate | 2023-01-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Pain and Therapy |
| spelling | doaj.art-64f7c96bbce545b9b1436633e495d64f2023-03-26T11:06:14ZengAdis, Springer HealthcarePain and Therapy2193-82372193-651X2023-01-0112247548910.1007/s40122-023-00474-5Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective StudyMei Xu0Yuerou Feng1Xiong Song2Shuwen Fu3XiaoFan Lu4Jielan Lai5Yali Lu6Xudong Wang7Renchun Lai8State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer MedicineState Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer MedicineState Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer MedicineState Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer MedicineState Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer MedicineState Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer MedicineState Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer MedicineState Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer MedicineState Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer MedicineAbstract Introduction Thoracic paravertebral block (TPVB) and subcostal transverse abdominis plane block (TAP) have been considered to provide an effective analgesic effect for laparoscopic and thoracoscopic surgery, respectively. The purpose of this randomized, controlled, and prospective study was to evaluate the analgesic effect of TPVB combined with TAP in patients undergoing total minimally invasive Mckeown esophagectomy. Methods Between February 2020 and December 2021, a total of 168 esophageal cancer patients undergoing McKeown esophagectomy at the Cancer Center of Sun Yat-Sen University, China, were randomly assigned to receive patient-controlled epidural analgesia alone (group PCEA, n = 56), patient-controlled intravenous analgesia alone (group PCIA, n = 56), and TPVB combined with TAP and patient-controlled intravenous analgesia (group PVB, n = 56). The primary outcome was a visual analogue scale (VAS) pain score on movement 48 h postoperatively. Secondary endpoints were pain scores at other points, intervention-related side effects, surgical complications, and length of intensive care unit and hospital stay. For the VAS pain score, the Kruskal–Wallis method was conducted for comparison of 3 treatment groups and further pairwise comparison with Bonferroni correction. Results On movement, the VAS in the PVB group was higher than that in the PCEA group at 48 h, 72 h, 96 h, and 120 h postoperatively (p < 0.05) except in the postoperative anesthesia care unit (PACU) and 24 h postoperatively. The VAS in the PCIA group was higher than the PCEA and PVB groups in the first 4 days after surgery. The pulmonary complication rate in the PCIA group was significantly higher than the rate in the PCEA [95% Confidence Interval 0.214 (0.354, 0.067), p = 0.024]. Conclusions Combined TPVB and TAP was more effective than intravenous opioid analgesia alone, while PCEA was more effective than TPVB combined with TAP and intravenous opioid analgesia for patients after McKeown esophagectomy. Trial Registration Chinese Clinical Trial Registry; ChiCTR2000029588.https://doi.org/10.1007/s40122-023-00474-5Thoracic paravertebral blockTransverse abdominis plane blockMcKeown esophagectomyPostoperative pain |
| spellingShingle | Mei Xu Yuerou Feng Xiong Song Shuwen Fu XiaoFan Lu Jielan Lai Yali Lu Xudong Wang Renchun Lai Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective Study Pain and Therapy Thoracic paravertebral block Transverse abdominis plane block McKeown esophagectomy Postoperative pain |
| title | Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective Study |
| title_full | Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective Study |
| title_fullStr | Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective Study |
| title_full_unstemmed | Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective Study |
| title_short | Combined Ultrasound-Guided Thoracic Paravertebral Nerve Block with Subcostal Transversus Abdominis Plane Block for Analgesia After Total Minimally Invasive Mckeown Esophagectomy: A Randomized, Controlled, and Prospective Study |
| title_sort | combined ultrasound guided thoracic paravertebral nerve block with subcostal transversus abdominis plane block for analgesia after total minimally invasive mckeown esophagectomy a randomized controlled and prospective study |
| topic | Thoracic paravertebral block Transverse abdominis plane block McKeown esophagectomy Postoperative pain |
| url | https://doi.org/10.1007/s40122-023-00474-5 |
| work_keys_str_mv | AT meixu combinedultrasoundguidedthoracicparavertebralnerveblockwithsubcostaltransversusabdominisplaneblockforanalgesiaaftertotalminimallyinvasivemckeownesophagectomyarandomizedcontrolledandprospectivestudy AT yueroufeng combinedultrasoundguidedthoracicparavertebralnerveblockwithsubcostaltransversusabdominisplaneblockforanalgesiaaftertotalminimallyinvasivemckeownesophagectomyarandomizedcontrolledandprospectivestudy AT xiongsong combinedultrasoundguidedthoracicparavertebralnerveblockwithsubcostaltransversusabdominisplaneblockforanalgesiaaftertotalminimallyinvasivemckeownesophagectomyarandomizedcontrolledandprospectivestudy AT shuwenfu combinedultrasoundguidedthoracicparavertebralnerveblockwithsubcostaltransversusabdominisplaneblockforanalgesiaaftertotalminimallyinvasivemckeownesophagectomyarandomizedcontrolledandprospectivestudy AT xiaofanlu combinedultrasoundguidedthoracicparavertebralnerveblockwithsubcostaltransversusabdominisplaneblockforanalgesiaaftertotalminimallyinvasivemckeownesophagectomyarandomizedcontrolledandprospectivestudy AT jielanlai combinedultrasoundguidedthoracicparavertebralnerveblockwithsubcostaltransversusabdominisplaneblockforanalgesiaaftertotalminimallyinvasivemckeownesophagectomyarandomizedcontrolledandprospectivestudy AT yalilu combinedultrasoundguidedthoracicparavertebralnerveblockwithsubcostaltransversusabdominisplaneblockforanalgesiaaftertotalminimallyinvasivemckeownesophagectomyarandomizedcontrolledandprospectivestudy AT xudongwang combinedultrasoundguidedthoracicparavertebralnerveblockwithsubcostaltransversusabdominisplaneblockforanalgesiaaftertotalminimallyinvasivemckeownesophagectomyarandomizedcontrolledandprospectivestudy AT renchunlai combinedultrasoundguidedthoracicparavertebralnerveblockwithsubcostaltransversusabdominisplaneblockforanalgesiaaftertotalminimallyinvasivemckeownesophagectomyarandomizedcontrolledandprospectivestudy |