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Shaker EH, Elshal MM, Gamal RM, Zayed NOA, Samy SF, Reyad RM, Shaaban MH, Abd Alrahman AAM, Abdelgalil AS. Ultrasound-guided continuous erector spinae plane block vs continuous thoracic epidural analgesia for the management of acute and chronic postthoracotomy pain: a randomized, controlled,double-blind trial. Pain Rep 2023; 8:e1106. [PMID: 38027467 PMCID: PMC10631608 DOI: 10.1097/pr9.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Postthoracotomy pain (PTP) is a severe pain complicating thoracic surgeries and its good management decreases the risk of PTP syndrome (PTPS). Objectives This randomized controlled study evaluated the efficacy of ultrasound-guided continuous erector spinae plane block (ESPB) with or without dexmedetomidine compared with thoracic epidural analgesia (TEA) in managing acute postoperative pain and the possible emergence of PTPS. Methods Ninety patients with chest malignancies planned for thoracotomy were randomly allocated into 3 equal groups. Group 1: TEA (20 mL of levobupivacaine 0.25% bolus, then 0.1 mL/kg/h of levobupivacaine 0.1%), group 2: ESPB (20 mL of levobupivacaine only 0.1% bolus every 6 hours), and group 3: ESPB (20 mL of levobupivacaine 0.25% and 0.5 μg/kg of dexmedetomidine Hcl bolus every 6 hours). Results Resting and dynamic visual analog scales were higher in group 2 compared with groups 1 and 3 at 6, 24, and 36 hours and at 8 and 12 weeks. Postthoracotomy pain syndrome incidence was higher in group 2 compared with groups 1 and 3 at 8 and 12 weeks, whereas it was indifferent between groups 1 and 3. The grading system for neuropathic pain score was higher in group 2 compared with groups 1 and 3 at 8 and 12 weeks, whereas it was indifferent between groups 1 and 3. Itching, pruritis, and urine retention were higher in group 1 than in ESPB groups. Conclusion Ultrasound-guided ESPB with dexmedetomidine is as potent as TEA in relieving acute PTP and reducing the possible emergence of chronic PTPS. However, the 2 techniques were superior to ESPB without dexmedetomidine. Erector spinae plane block has fewer side effects compared with TEA.
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Affiliation(s)
- Ehab Hanafy Shaker
- Department of Anesthesia, Intensive Care, and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
| | - Mamdouh Mahmoud Elshal
- Department of Anesthesia, Intensive Care, and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
| | - Reham Mohamed Gamal
- Department of Anesthesia, Intensive Care, and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
| | - Norma Osama Abdallah Zayed
- Department of Anesthesia, Intensive Care, and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
| | - Samuel Fayez Samy
- Department of Anesthesia, Intensive Care, and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
| | - Raafat M. Reyad
- Department of Anesthesia, Intensive Care, and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
| | - Mohammed H. Shaaban
- Department of Diagnostic & Interventional Radiology, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Ahmed Salah Abdelgalil
- Department of Anesthesia, Intensive Care, and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
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Pérez BR, Martínez CP, Jiménez CP. Thoracic transversus plane block as part of a multimodal analgesia plan in a cat undergoing sternotomy. VETERINARY RECORD CASE REPORTS 2023. [DOI: 10.1002/vrc2.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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Ling Q, Zhao S, Shi Y, Li X, Li P, Zhao G, Zhu Q. Transversus Thoracis Muscle Plane Block in Paediatric Patients Who Underwent Minimally Invasive Closure of Transthoracic Ventricular Septal Defect: A Retrospective Study. Pain Res Manag 2023; 2023:3488552. [PMID: 36999119 PMCID: PMC10049843 DOI: 10.1155/2023/3488552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023]
Abstract
Objective Minimally invasive closure of transthoracic ventricular septal defect (VSD) has been widely used in paediatric patients. This retrospective study aimed to explore the use of transversus thoracis muscle plane block (TTMPB) in the minimally invasive closure of transthoracic VSD in paediatric patients. Methods From September 28, 2017, to July 25, 2022, a total of 119 paediatric patients scheduled for minimally invasive transthoracic VSD closure were considered for inclusion. Results In total, 110 patients were included in the final analysis. Perioperative fentanyl consumption of the TTMPB group was not different from that of the non-TTMPB group (5.90 ± 1.32 μg/kg vs. 6.25 ± 1.74 μg/kg, p = 0.473). Both the time to extubation and postanesthesia care unit (PACU) stay were significantly shorter in the TTMPB group than in the non-TTMPB group (10.94 ± 10.31 min vs. 35.03 ± 23.52 min for extubation, and 42.55 ± 16.83 min vs. 59.98 ± 27.94 min for PACU stay, both p < 0.001). Furthermore, the postoperative paediatric intensive care unit (PICU) stay in the TTMPB group was significantly shorter than in the non-TTMPB group (1.04 ± 0.28 d vs. 1.34 ± 1.05 d, p = 0.005). Multivariate analysis demonstrated that TTMPB was significantly associated with shorter time to extubation (p < 0.001) and PACU stay (p = 0.001) but not postoperative PICU stay (p = 0.094). Discussion. This study showed that TTMPB was a beneficial and safe regional anaesthesia technique for paediatric patients who underwent minimally invasive closure of transthoracic VSD, although prospective randomized controlled trials are needed to confirm the results.
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Affiliation(s)
- Qiong Ling
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuhua Zhao
- 2Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Yongyong Shi
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangyu Li
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ping Li
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gaofeng Zhao
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qianqian Zhu
- 2Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
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A Two-Point Ultrasound-Guided Injection Technique for the Transversus Thoracis Plane Block: A Canine Cadaveric Study. Animals (Basel) 2022; 12:ani12172165. [PMID: 36077885 PMCID: PMC9454867 DOI: 10.3390/ani12172165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary The transversus thoracis plane block is a locoregional technique recently described in canine cadavers to desensitize the intercostal nerves running through this plane. In canine cadavers, a transverse approach through a single injection point at the fifth intercostal space has been described, although consistent staining of the intercostal nerves was not completely achieved. The objective of this study was twofold: (1) to evaluate if the transverse approach is feasible at the third and sixth intercostal spaces and (2) to compare, by anatomical dissection, the spread of a dye solution and the staining of the intercostal nerves when a low volume (0.5 mL kg−1) or a high volume (1 mL kg−1) was equally divided at a two-point injection in the same hemithorax. Our results showed that the injection of the high-volume dye solution, equally injected at the third and sixth intercostal spaces using the transverse approach, achieved a consistent staining of from T2 to T7 intercostal nerves. This block could achieve adequate desensitization of the ventral chest wall during sternotomy in the dog. Clinical studies in live animals are necessary to confirm the efficacy of this technique. Abstract The transversus thoracis plane (TTP) block desensitizes the intercostal nerves that run through this plane, providing analgesia to the ventral thoracic wall. Two canine cadavers were used to assess the feasibility of the transverse approach for the TTP (t-TTP) under ultrasound guidance to inject a solution at the third and sixth intercostal spaces. Eight cadavers were used to compare the spread and number of intercostal nerves that were stained when a low volume (LV) 0.5 mL kg−1 or a high volume (HV) 1 mL kg−1 of a dye-lidocaine solution was injected into the same hemithorax, injecting the volume equally at these intercostal spaces using the transverse approach. Fisher’s exact test and Wilcoxon signed-rank test were used to contrast the spread of the different volume solutions. The injectate spread along the TTP after all injections, dying a median number (range) of 3 (2–5) and 6 (5–6) nerves with LV and HV, respectively (p = 0.011). The two-point injection of HV, using the t-TTP approach, is a feasible technique that provides a consistent staining from T2 to T7 intercostal nerves. The injection of HV instead of LV increases the spread and enhances the number of stained intercostal nerves.
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Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148696. [PMID: 35886547 PMCID: PMC9320164 DOI: 10.3390/ijerph19148696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.
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The quality of recovery after erector spinae plane block in patients undergoing breast surgery: a randomized controlled trial. BMC Anesthesiol 2022; 22:222. [PMID: 35836116 PMCID: PMC9281119 DOI: 10.1186/s12871-022-01760-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The erector spinae plane (ESP) block has recently been shown to effectively alleviate postoperative pain and reduce opioid consumption in breast surgery patients. However, data are still limited concerning the quality of recovery in patients following this procedure. METHODS This study was a randomized controlled trial (RCT) performed in a university hospital. We randomly allocated patients to one of three groups: ESP, SHAM, and control (CON). Procedures in the ESP and SHAM blocks were performed ipsilaterally with 0.375% ropivacaine or 0.9% saline (0.4 mL/kg). Our primary outcome was the assessment of the patient's improvement with quality-of-recovery 40 (QoR-40) a day after surgery. Other outcome assessments included postoperative pain evaluation on the visual analog scale (VAS), 24-hour opioid consumption with patient-controlled analgesia (PCA), time to the first opioid demand, and global satisfaction with perioperative treatment. RESULTS Overall, patients in the ESP group had improved QoR-40 compared to the CON group, 186 [177-193] vs. 175 [165-183] (medians and interquartile ranges). Pain severity was significantly higher in the CON group compared to the ESP group at hours 2 (38 [23-53] vs. 20 [7-32]) and 4 (30 [18-51] vs. 19 [7-25]). Moreover, we observed lower oxycodone consumption after 24 hours with the PCA pump between the ESP (4 [2-8] mg) and the CON (9.5 [5-19]) groups. Patients in the CON group used PCA sooner than those in the ESP group. Participants in the ESP group were more satisfied with treatment than those in the CON group. We found no statistical difference between SHAM and the other groups. CONCLUSIONS Compared to the CON group, the ESP block improved the quality of recovery, alleviated pain intensity, and lowered opioid consumption in patients undergoing breast surgery. However, we did not observe this superiority in comparison with the SHAM group. TRIAL REGISTRATION NCT04726878 .
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Yürük D, Akkaya ÖT, Polat ÖE, Alptekin HA. Ultrasound-Guided Erector Spinae Plane Block and Trapezius Muscle Injection for Myofascial Pain Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:185-191. [PMID: 33713473 DOI: 10.1002/jum.15694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/28/2021] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There were two goals to this study: the first goal was to research the analgesic effectiveness of erector spinae plane block (ESPB) added to the treatment after trapezius muscle injection (TMI) and the second was to investigate whether repeated TMI increases the analgesic effect in myofascial pain syndrome (MPS). METHODS Sixty patients with a diagnosis of MPS were randomized into two groups. The TMI group (n = 30) received ultrasound-guided (USG) TMI with 5 mL of 0.25% bupivacaine two times, with a 1-week interval in between. The ESPB group (n = 30) received USG TMI with 5 mL of 0.25% bupivacaine in the first week and USG ESPB with 20 mL of 0.125% bupivacaine in the second week. The pain severity of the patients was evaluated using the visual analog scale (VAS). The data obtained before (week 0) and after (weeks 1, 2, 3, and 4) the injections were statistically compared between the groups. RESULTS In both groups, the mean VAS score decreased in the first week compared to the mean pretreatment score (p < .001). When the VAS scores were compared between the first and second weeks, a decrease was observed in both groups (p < .001), but it was more evident in the ESPB group. Compared to previous weeks, there was no significant difference in VAS scores at the third and fourth weeks. CONCLUSIONS The analgesic effect of repeated TMI for MPS was superior to a single injection, but ESPB combined with TMI provided more effective analgesia than repeated TMI.
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Affiliation(s)
- Damla Yürük
- Department of Algology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ömer Taylan Akkaya
- Department of Algology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Özgür Emre Polat
- Department of Algology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Hüseyin Alp Alptekin
- Department of Algology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Hakim SM. Parasternal plane block: a new technique added to our armamentarium, or a new issue added to our debates? Minerva Anestesiol 2021; 87:1284-1286. [PMID: 34874134 DOI: 10.23736/s0375-9393.21.16222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sameh M Hakim
- Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt -
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Sepolvere G, Coppolino F, Tedesco M, Cristiano L. Ultrasound-guided parasternal blocks: techniques, clinical indications and future prospects: a narrative review. Minerva Anestesiol 2021; 87:1338-1346. [PMID: 34633167 DOI: 10.23736/s0375-9393.21.15599-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fascial plane blocks represent anesthetic procedures performed to manage perioperative and chronic pain. Recently, many fascial blocks techniques have been described increasing their field of applications. They offer anesthetic and analgesic efficacy, easy of execution and low risk of complications. The newest techniques recently described are the ultrasound parasternal blocks (USPSB) which provide analgesia to the antero-medial chest wall. In particular, the antero-medial chest wall blocks are performed to provide analgesia and anesthesia in several and different surgeries such as median sternotomy, breast surgery, implantable cardioverter-defibrillator implantation and in the management of acute and chronic pain. The nervous target for these blocks is represented by the anterior branches of the intercostal nerves which enter the intercostal (ICM) and pectoralis major (PMM) muscles innervating the antero-medial region of chest wall, the main cause of poststernotomy pain. Local anesthetic is injected deep to PMM and superficial to the ICM or between the internal thoracic muscle (IIM) and transversus thoracis muscle (TTM). So, essentially these blocks may be described as superficial or deep parasternal-intercostal plane blocks, based on where the target nerves are hunted. Even if they all provide analgesia to the antero-medial chest wall, the anatomical injection site represents the main peculiarity that differentiates these techniques. To date, a common nomenclature for antero-medial chest wall blocks or parasternal-intercostal plane blocks is not yet well defined and a standardized nomenclature is needed to ensure an adequate communication among anesthesiologists.
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Affiliation(s)
- Giuseppe Sepolvere
- Intensive Care Unit, Department of Anesthesia and Cardiac Surgery, San Michele Hospital, Maddaloni, Caserta, Italy -
| | - Francesco Coppolino
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Tedesco
- Department of Anesthesia and Intensive Care Unit and Pain Therapy, Mater Dei Hospital, Bari, Italy
| | - Loredana Cristiano
- Intensive Care Unit, Department of Anesthesia and Cardiac Surgery, San Michele Hospital, Maddaloni, Caserta, Italy
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Description of an Ultrasound-Guided Transverse Approach to the Transversus Thoracis Plane Block and Evaluation of Injectate Spread in Canine Cadavers. Animals (Basel) 2021; 11:ani11092657. [PMID: 34573624 PMCID: PMC8466234 DOI: 10.3390/ani11092657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary In humans, the aim of the transversus thoracis plane block is to desensitise the intercostal nerves running through this plane, providing analgesia to the anterior chest wall. Our objective was twofold: describing an ultrasound-guided transverse approach to the transversus thoracis plane and evaluating the spread of two injectable volumes in canine cadavers. Gross anatomy of the ventral thoracic area and sonoanatomy between the fifth and sixth costal cartilages were described in two dog cadavers. Eight cadavers were used to describe this approach and were subsequently dissected to evaluate the injectate spread and the intercostal nerves staining after low volume (0.5 mL kg−1) and high volume (1 mL kg−1) dye-lidocaine injection. After all injections, the injectable solution was distributed along the transversus thoracis plane, staining a median number (range) of 3 (2–4) and 4 (3–5) nerves with low and high volume, respectively (p = 0.014). The transverse approach to the transversus thoracis plane is a feasible, single injection point technique that provides the staining of several intercostal nerves. The injection of high versus low volume increases the number of stained nerves. Abstract Transversus thoracis plane (TTP) block has demonstrated to produce analgesia in humans undergoing median sternotomy. The objectives of the study were to describe an ultrasound-guided transverse approach to the transversus thoracis plane (t-TTP) and to evaluate the spread of two injectable volumes in canine cadavers. Two cadavers were used to describe relevant gross anatomy of the ventral thoracic area and sonoanatomy between the fifth and sixth costal cartilages. Then, eight cadavers were used to describe the ultrasound-guided injection into the TTP and were dissected to evaluate the injectate spread and the intercostal nerves staining with two different dye-lidocaine volumes: low volume (LV) 0.5 mL kg−1 and high volume (HV) 1 mL kg−1. To compare the spread between both volumes the Fisher’s exact test and Wilcoxon signed-rank test were used. The solution spread along the TTP after all injections, staining a median number (range) of 3 (2–4) and 4 (3–5) nerves with LV and HV, respectively (p = 0.014). The injection of HV versus LV increases the number of stained nerves. Ultrasound-guided t-TTP is a feasible technique that provides staining of several intercostal nerves with a single injection site, so it could be useful to provide analgesia to the ventral chest wall.
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The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN 2021; 68:338-345. [PMID: 34140270 DOI: 10.1016/j.redare.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/10/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Breast cancer is the most commonly occurring cancer among women. Among its treatment sequelae is chronic neuropathic pain after breast surgery (CNPBS). Pain management is difficult and classicaly consists in a pharmacological approach, however recent studies have advocated the use of locoregional techniques as adjuvants. Serratus plane block (SPB) has recently emerged as a potential tool for the control of CNPBS. This study aims to evaluate the efficacy and potencial role of the ultrasound-guided SPB on CNPBS. METHODS A retrospective analysis was performed on 30 patients with CNPBS refractory to drug therapy, who underwent SPB between 2017-2019. The following parameters were analyzed: basal pain, pain at 24 h, 1 week and at 1 month. The Mann-Whitney test was applied. Statistical significance was considered at the level of p < 0.05. All statistical analysis was performed with SPSS 20. RESULTS 3 patients were excluded. At 24 h, we report pain improvement (at least 30% reduction on basal pain score) on 20 patients and after 1 week on 12. At 1 month after, 22 patients had improved, from these: 11 improved with no therapeutic adjustment; 11 patients improved with therapeutic adjustment (8 in gabapentinoid monotherapy, 3 with introduction of polytherapy). 5 patients didn't improve. CONCLUSION Our study demonstrated SPB as a valid alternative for CNPBS management when pharmacologic therapy has been proven insufficient, with no side effects reported. Randomized studies are needed to assess the magnitude of SPB on CNPBS and to identify the patients who benefit the most from SPB.
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Hung CJ, Lin YC. Add-on therapy of interfascial hydrodissection to trigger point injection for myofascial pain? J Chin Med Assoc 2021; 84:453. [PMID: 33323687 DOI: 10.1097/jcma.0000000000000472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Chih-Jen Hung
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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Chen H, Song W, Wang W, Peng Y, Zhai C, Yao L, Xia Z. Ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in mediastinal mass resection by median sternotomy: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 2021; 21:98. [PMID: 33784983 PMCID: PMC8011112 DOI: 10.1186/s12871-021-01291-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ultrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear. This study aimed to evaluate the effectiveness of ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in patients undergoing median sternotomy for mediastinal mass resection. METHODS This randomized, double-blind, placebo-controlled trial performed in Renmin Hospital, Wuhan University, enrolled 41 participants aged 18-65 years. The patients scheduled for mediastinal mass resection by median sternotomy were randomly assigned were randomized into 2 groups, and preoperatively administered 2 injections of ropivacaine (PSI) and saline (control) groups, respectively, in the 3rd and 5th parasternal intercostal spaces with ultrasound-guided (USG) bilateral parasternal intercostal nerve block. Sufentanil via patient-controlled intravenous analgesia (PCIA) was administered to all participants postoperatively. Pain score, total sufentanil consumption, and postoperative adverse events were recorded within the first 24 h. RESULTS There were 20 and 21 patients in the PSI and control group, respectively. The PSI group required 20% less PCIA-sufentanil compared with the control group (54.05 ± 11.14 μg vs. 67.67 ± 8.92 μg, P < 0.001). In addition, pain numerical rating scale (NRS) scores were significantly lower in the PSI group compared with control patients, both at rest and upon coughing within 24 postoperative hours. Postoperative adverse events were generally reduced in the PSI group compared with controls. CONCLUSIONS USG bilateral parasternal intercostal nerve block effectively reduces postoperative pain and adjuvant analgesic requirement, with good patient satisfaction, therefore constituting a good option for mediastinal mass resection by median sternotomy.
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Affiliation(s)
- Hexiang Chen
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Wenqin Song
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Wei Wang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Yawen Peng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Chunchun Zhai
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China.
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Dos Santos Rodrigues da Silva MJ, Lousame AA, Ferreira MLN, Fernandez Gacio M, Miranda MLC. The role of ultrasound guided serratus plane block on chronic neuropathic pain after breast surgery in cancer patient. ACTA ACUST UNITED AC 2021; 68:338-345. [PMID: 33627290 DOI: 10.1016/j.redar.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Breast cancer is the most commonly occurring cancer among women. Among its treatment sequelae is chronic neuropathic pain after breast surgery (CNPBS). Pain management is difficult and classicaly consists in a pharmacological approach, however recent studies have advocated the use of locoregional techniques as adjuvants. Serratus plane block (SPB) has recently emerged as a potential tool for the control of CNPBS. This study aims to evaluate the efficacy and potencial role of the ultrasound-guided SPB on CNPBS. METHODS A retrospective analysis was performed on 30 patients with CNPBS refractory to drug therapy, who underwent SPB between 2017-2019. The following parameters were analyzed: basal pain, pain at 24 hours, 1 week and at 1 month. The Mann-Whitney test was applied. Statistical significance was considered at the level of p < 0.05. All statistical analysis was performed with SPSS 20. RESULTS 3 patients were excluded. At 24 hours, we report pain improvement (at least 30% reduction on basal pain score) on 20 patients and after 1 week on 12. At 1 month after, 22 patients had improved, from these: 11 improved with no therapeutic adjustment; 11 patients improved with therapeutic adjustment (8 in gabapentinoid monotherapy, 3 with introduction of polytherapy). 5 patients didn't improve. CONCLUSIóN: Our study demonstrated SPB as a valid alternative for CNPBS management when pharmacologic therapy has been proven insufficient, with no side effects reported. Randomized studies are needed to assess the magnitude of SPB on CNPBS and to identify the patients who benefit the most from SPB.
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Affiliation(s)
| | - A A Lousame
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
| | - M L N Ferreira
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
| | - M Fernandez Gacio
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
| | - M L C Miranda
- Departamento de Anestesiología y Cuidados Intensivos, Instituto Portugués de Oncología de Porto, Porto, Portugal
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15
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Piraccini E, Calli M, Taddei S, Maitan S. Erector spinae plane block and rhomboid intercostal block for the treatment of post-mastectomy pain syndrome. Saudi J Anaesth 2020; 14:517-519. [PMID: 33447197 PMCID: PMC7796725 DOI: 10.4103/sja.sja_203_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
Post-mastectomy pain syndrome (PMPS) can have multiple pain generators, including neuropathic pain and myofascial pain syndrome (MPS). Erector spinae plane (ESP) block and rhomboid intercostal block (RIB) have been used to provide anesthesia of the thorax and also for some chronic pain conditions. We describe a 43-year-old man suffering from right PMPS after right mastectomy, full axillary, and mammary lymph node dissection. We treated her with ESP blocks and RIB to reduce neuralgia and MPS: Neuropathic pain disappeared and the patient experienced only slight residual pain. The result was maintained 3 months later. This report suggests that ESP block and RIB with local anesthetic and corticosteroids with might be useful to treat a PMPS.
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Affiliation(s)
- Emanuele Piraccini
- Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Bologna, Italy
| | - Morena Calli
- Department of Surgery, Anesthesia and Intensive Care Section "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Stefania Taddei
- Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Bologna, Italy
| | - Stefano Maitan
- Department of Surgery, Anesthesia and Intensive Care Section "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
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16
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Kongsagul S, Vitoonpong T, Kitisomprayoonkul W, Tantisiriwat N. Ultrasound-Guided Physiological Saline Injection for Patients with Myofascial Pain. J Med Ultrasound 2020; 28:99-103. [PMID: 32874868 PMCID: PMC7446687 DOI: 10.4103/jmu.jmu_54_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/23/2019] [Accepted: 09/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Based on the histological confirmation of the presence of nerve structure in the fascia, hence, myofascial pain was treated by the mechanism referred to as interfascial block. To date, the studies of physiological saline for treating patients with myofascial pain has been limited. Ultrasound (US) guided with physiological saline injection (PSI) technique has been routinely practiced among patients with myofascial pain in outpatient service at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. The main objective of this present study is to find the overview data including the percentage of patients responding, acceptable pain period, and adverse events. Materials and Methods: Electronic medical reports among 142 patients receiving US-guided PSI from August 1, 2016, to November 20, 2017, at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, were retrospectively reviewed by the first author. Procedures were performed by the last author. The analysis was independently performed by the first author. Results: One hundred and forty-two patients with complete medical records were compatible with analysis. The average age of patients was 55 years. Most of the patients were female (68.3%). Most of the patients (76.8%) had chronic suffering from myofascial pain. Approximately half of the patients (56.4%) are currently received pain-relieving medications. Upper trapezius muscle (19.5%) was the most common muscle receiving the procedure, followed by multifidus (10.0%) and quadratus lumborum (9.5%). Most of the patients (86.8%) received the procedure one muscle. Approximately 30% of the patients were able to stop pain-relieving medications after the procedure. The median of acceptable pain period was 63 days. The percentage of patients having an acceptable pain period >3 months was 43.9%. No major adverse events were demonstrated. Conclusion: US-guided PSI technique demonstrated pain reduction in 72.8% of the analyzed patients, with an acceptable pain period of 63 days. No major adverse events were demonstrated among all the patients. This technique should be considered as another invasive procedure for eradication myofascial trigger point.
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Affiliation(s)
- Sussaya Kongsagul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Timporn Vitoonpong
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Rehabilitation Medicin, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Wasuwat Kitisomprayoonkul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natthiya Tantisiriwat
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Rehabilitation Medicin, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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17
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Aydin ME, Celik M, Celik EC, Ahiskalioglu EO, Selvitopi K. Transversus thoracic muscle plane block for persistent parasternal pain: The Tietze syndrome. J Clin Anesth 2020; 63:109755. [DOI: 10.1016/j.jclinane.2020.109755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
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18
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Piraccini E, Byrne H, Taddei S. Pecto intercosto fascial block can be useful to treat Tietze syndrome. J Clin Anesth 2020; 64:109825. [PMID: 32305792 DOI: 10.1016/j.jclinane.2020.109825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Emanuele Piraccini
- Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Bologna, Italy.
| | - Helen Byrne
- Kingsbridge Medical Diagnostics, Kingsbridge Healthcare Group, Belfast, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Stefania Taddei
- Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Bologna, Italy
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19
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Arasu T, Ragavendran S, Nagaraja PS, Singh NG, Vikram MN, Basappanavar VS. Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion - A pilot study. Ann Card Anaesth 2020; 23:183-188. [PMID: 32275033 PMCID: PMC7336976 DOI: 10.4103/aca.aca_254_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Pectoral nerve (PECS1) block has been used for patients undergoing cardiac implantable electronic device (CIED) insertions, however, PECS1 block alone may lead to inadequate analgesia during tunneling and pocket creation because of the highly innervated chest wall. Transversus thoracis muscle plane (TTM) block targeting the anterior branches of T2-T6 intercostal nerves can be effectively used in combination with PECS1 for patients undergoing CIED insertion. The present study hypothesized that combined PECS1 and TTM blocks would provide effective analgesia for patients undergoing CIED insertion compared to PECS1 block alone. Materials and Methods Thirty adult patients between the age group of 18-85 years undergoing CIED insertion were enrolled in the study. A prospective, randomized, comparative, pilot study was conducted. A total of 30 patients were enrolled, who were randomized to either Group P: PECS1 block (n = 15) or Group PT: PECS1 and TTM blocks (n = 15). The intraoperative requirement of midazolam and local anesthetic and level of sedation by Ramsay sedation score were noted. The pain was assessed by visual analog scale (VAS) at rest and during a cough or deep breathing at 0 h, 3 h, 6 h, 12 h, and 24 h after the procedure. Results VAS scores at rest were significantly lower in group PT at 0, 3, 6, and 12 h postprocedure, and during cough at 0, 6, and 12 h after the procedure (P < 0.05). At 24 h, VAS scores were comparable between both groups. Intraoperative midazolam consumption was higher in group P compared to group PT (P= 0.002). Fourteen patients in group P received local anesthetic supplementation in comparison to only one patient in group PT (P = 0.0001). Thirteen patients in group P received the first rescue analgesia in comparison to three patients in group PT (P = 0.0003). Conclusion Combined PECS1 and TTM blocks provide superior analgesia, reduced net consumption of local anesthetic, sedative agents, and rescue analgesics compared to PECS1 block alone in patients undergoing CIED insertion.
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Affiliation(s)
- Thanigai Arasu
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - S Ragavendran
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - P S Nagaraja
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - Naveen G Singh
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - Manjunatha N Vikram
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - Vikram Somashekhar Basappanavar
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
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20
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Arasu T, Ragavendran S, Nagaraja PS, Singh NG, Vikram MN, Basappanavar VS. Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion - A pilot study. Ann Card Anaesth 2020; 23:165-169. [PMID: 32275030 PMCID: PMC7336977 DOI: 10.4103/aca.aca_255_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/20/2019] [Accepted: 09/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Pectoral nerve (PECS1) block has been used for patients undergoing cardiac implantable electronic device (CIED) insertions, however, PECS1 block alone may lead to inadequate analgesia during tunneling and pocket creation because of the highly innervated chest wall. Transversus thoracis muscle plane (TTM) block targeting the anterior branches of T2-T6 intercostal nerves can be effectively used in combination with PECS1 for patients undergoing CIED insertion. The present study hypothesized that combined PECS1 and TTM blocks would provide effective analgesia for patients undergoing CIED insertion compared to PECS1 block alone. Materials and Methods Thirty adult patients between the age group of 18-85 years undergoing CIED insertion were enrolled in the study. A prospective, randomized, comparative, pilot study was conducted. A total of 30 patients were enrolled, who were randomized to either Group P: PECS1 block (n = 15) or Group PT: PECS1 and TTM blocks (n = 15). The intraoperative requirement of midazolam and local anesthetic and level of sedation by Ramsay sedation score were noted. The pain was assessed by visual analog scale (VAS) at rest and during a cough or deep breathing at 0 h, 3 h, 6 h, 12 h, and 24 h after the procedure. Results VAS scores at rest were significantly lower in group PT at 0, 3, 6, and 12 h postprocedure, and during cough at 0, 6, and 12 h after the procedure (P < 0.05). At 24 h, VAS scores were comparable between both groups. Intraoperative midazolam consumption was higher in group P compared to group PT (P= 0.002). Fourteen patients in group P received local anesthetic supplementation in comparison to only one patient in group PT (P = 0.0001). Thirteen patients in group P received the first rescue analgesia in comparison to three patients in group PT (P = 0.0003). Conclusion Combined PECS1 and TTM blocks provide superior analgesia, reduced net consumption of local anesthetic, sedative agents, and rescue analgesics compared to PECS1 block alone in patients undergoing CIED insertion.
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Affiliation(s)
- Thanigai Arasu
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - S Ragavendran
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - PS Nagaraja
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - Naveen G Singh
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - Manjunatha N Vikram
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
| | - Vikram Somashekhar Basappanavar
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bangalore, Karnataka, India
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21
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Piraccini E, Biondi G, De Lorenzo E, Corso RM, Maitan S. Ultrasound-guided erector spinae block for post-thoracotomy pain syndrome in video-assisted thoracic surgery. TUMORI JOURNAL 2020; 106:NP46-NP48. [PMID: 32194005 DOI: 10.1177/0300891620912024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes our experience with 5 patients with post-thoracotomy pain syndrome after video-assisted thoracoscopic lobectomies, treated with weekly erector spinae plane block. We injected corticosteroid and local anesthetic. At the end of the treatment period, pain scores decreased significantly. Our experience suggests that erector spinae plane block may have a role in the treatment of post-thoracoscopy pain syndrome.
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Affiliation(s)
- Emanuele Piraccini
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Giulia Biondi
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Eleonora De Lorenzo
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Ruggero M Corso
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Stefano Maitan
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
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22
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Regional anesthesia considerations for cardiac surgery. Best Pract Res Clin Anaesthesiol 2019; 33:387-406. [DOI: 10.1016/j.bpa.2019.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 01/22/2023]
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23
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Piraccini E, Calli M, Corso RM, Maitan S. Pectointercostal fascial block (PIFB) and parasternal block (PSB): Two names for the same block? J Clin Anesth 2019; 58:130. [DOI: 10.1016/j.jclinane.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/26/2019] [Indexed: 02/01/2023]
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24
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Song W, Wang W, Zhan L. Perioperative analgesia during thymectomy via median sternotomy. Anaesthesist 2019; 68:848-851. [DOI: 10.1007/s00101-019-00700-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/28/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022]
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25
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Transversus Thoracis Muscle Plane Block. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1716365. [PMID: 31360703 PMCID: PMC6642770 DOI: 10.1155/2019/1716365] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/25/2019] [Accepted: 06/09/2019] [Indexed: 11/18/2022]
Abstract
The transversus thoracis muscle plane block (TTP) block is a newly developed regional anesthesia technique which provides analgesia to the anterior chest wall. Since its introduction, this technique has been utilized for a wide range of surgical procedures as well as nonsurgical indications. Current evidence suggests that the TTP block provides effective analgesia for breast and cardiac surgeries, cardiac device implantation, pericardiocentesis, and acute and chronic pain management. To date, no major complications have been reported. Currently there is an urgent need to standardize the nomenclature of this technique to facilitate accurate communication amongst care providers, researchers, and authors. In this review, we describe the TTP block technique, review the indications and available evidence in clinical practice, and discuss alternative blocks and future prospects.
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26
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Piraccini E, Biondi G, Corso RM, Maitan S. The use of rhomboid intercostal block, parasternal block and erector spinae plane block for breast surgery. J Clin Anesth 2019; 59:10. [PMID: 31176954 DOI: 10.1016/j.jclinane.2019.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/02/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Emanuele Piraccini
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy.
| | - Giulia Biondi
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Ruggero M Corso
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Stefano Maitan
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
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27
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Piraccini E, Corso RM, Maitan S. Ultrasound guided erector spinae plane block for myofascial pain syndrome. J Clin Anesth 2019; 57:121. [PMID: 30995595 DOI: 10.1016/j.jclinane.2019.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Emanuele Piraccini
- Department of Surgery, Anesthesia and Intensive Care Section "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy.
| | - Ruggero M Corso
- Department of Surgery, Anesthesia and Intensive Care Section "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Stefano Maitan
- Department of Surgery, Anesthesia and Intensive Care Section "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
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28
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Ultrasound-guided interfascial hydrodissection for severe pain in mastitis. J Clin Anesth 2019; 57:40. [PMID: 30852325 DOI: 10.1016/j.jclinane.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/03/2019] [Indexed: 11/20/2022]
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