1
|
Wang X, Jia X, Li Z, Zhou Q. Rhomboid intercostal block or thoracic paravertebral block for postoperative recovery quality after video-assisted thoracic surgery: A prospective, non-inferiority, randomised controlled trial. Eur J Anaesthesiol 2023; 40:652-659. [PMID: 37377368 DOI: 10.1097/eja.0000000000001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND The analgesic characteristics of rhomboid intercostal block (RIB) remain unclear. Before it can be fully recommended, we compared the recovery quality and analgesic effects of RIB and thoracic paravertebral block (TPVB) for video-assisted thoracoscopic surgery (VATS). OBJECTIVE The current study aimed to investigate whether there is a difference in postoperative recovery quality between TPVB and RIB. DESIGN A prospective, non-inferiority, randomised controlled trial. SETTING Affiliated Hospital of Jiaxing University in China from March 2021 to August 2022. PATIENTS Eighty patients aged 18 to 80 years, with ASA physical status I to III, and scheduled for elective VATS were enrolled in the trial. INTERVENTION Ultrasound-guided TPVB or RIB was performed with 20 ml 0.375% ropivacaine. MAIN OUTCOME MEASURES The primary outcome of the study was the mean difference of quality of recovery-40 scores 24 h postoperatively. The non-inferiority margin was defined as 6.3. Numeric rating scores (NRS) for pain at 0.5, 1, 3, 6, 12, 24 and 48 h postoperatively in all patients were also recorded. RESULTS A total of 75 participants completed the study. The mean difference of quality of recovery-40 scores 24 h postoperatively was -1.6 (95% CI, -4.5 to 1.3), demonstrating the non-inferiority of RIB to TPVB. There was no significant difference between the two groups in the area under the curve for pain NRS over time, at rest and on movement, at 6, 12, 24 and 48 h postoperatively (all P > 0.05), except for the area under the curve pain NRS over time on movement at 48 h postoperatively ( P = 0.046). There were no statistical differences between the two groups in the postoperative sufentanil use at 0 to 24 h or 24 to 48 h (all P > 0.05). CONCLUSION Our study suggests that RIB was non-inferior to TPVB for the quality of recovery, with almost the same postoperative analgesic effect as TPVB after VATS. CLINICAL TRIAL REGISTRATION chictr.org.cn: ChiCTR2100043841.
Collapse
Affiliation(s)
- Xuru Wang
- From the Department of Anaesthesiology and Pain Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China (XW, XJ, ZL, QZ)
| | | | | | | |
Collapse
|
2
|
Xu M, Zhang G, Tang Y, Wang R, Yang J. Impact of Regional Anesthesia on Subjective Quality of Recovery in Patients Undergoing Thoracic Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2023; 37:1744-1750. [PMID: 37301699 DOI: 10.1053/j.jvca.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Regional anesthesia can be effective for managing pain after thoracic surgery. This study evaluated whether it can also improve patient-reported quality of recovery (QoR) after such surgery. DESIGN Meta-analysis of randomized controlled trials. SETTING Postoperative care. INTERVENTION Perioperative regional anesthesia. PATIENTS Adults undergoing thoracic surgery. MEASUREMENTS AND MAIN RESULTS The primary outcome was total QoR scores 24 hours after surgery. Secondary outcomes were postoperative opioid consumption, pain scores, pulmonary function, respiratory complications, and other adverse effects. Eight studies were identified, of which 6 involving 532 patients receiving video-assisted thoracic surgery were included in the quantitative analysis of QoR. Regional anesthesia significantly improved QoR-40 score (mean difference 9.48; 95% CI 3.53-15.44; I2 = 89%; 4 trials involving 296 patients) and QoR-15 score (mean difference 6.7; 95% CI 2.58-10.82; I2 = 0%; 2 trials involving 236 patients). Regional anesthesia also significantly reduced postoperative opioid consumption and the incidence of nausea and vomiting. Insufficient data were available to meta-analyze the effects of regional anesthesia on postoperative pulmonary function or respiratory complications. CONCLUSIONS The available evidence suggests that regional anesthesia can enhance QoR after video-assisted thoracic surgery. Future studies should confirm and extend these findings.
Collapse
Affiliation(s)
- Min Xu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Guangchao Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yidan Tang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Wang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.
| |
Collapse
|
3
|
Ultrasound-Guided Rhomboid Block versus Paravertebral Block in Postoperative Analgesia for Video-Assisted Thoracoscopic Surgery: A Prospective Randomized Controlled Clinical Trial. Pain Res Manag 2023; 2023:3924511. [PMID: 36911242 PMCID: PMC9995189 DOI: 10.1155/2023/3924511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
Introduction The anesthetic efficacy of the ultrasound-guided rhomboid intercostal block (RIB) in alleviating postoperative pain has been well concerned. This study aims to compare the effectiveness between ultrasound-guided RIB and paravertebral block (PVB) in alleviating acute pain following video-assisted thoracic surgery. Methods It was a prospective, randomized, double-blinded clinical trial involving 132 patients with video-assisted thoracic surgery divided into three groups: the general anesthesia (GA) group, RIB group, and PVB group on T5 vertebra, using 0.4% ropivacaine at 3 mg/kg, registered in the Chinese Clinical Trial Registry (ChiCTR2100054057, "https://www.chictr.org.cn"). The visual analogue scale (VAS) scores at rest and cough during 48 h postoperatively and the postoperative consumption of pain rescue were the primary outcomes, and the QoR15 score 48 h postoperatively, the usage of opioids during and after operation, and nerve block-related complications were the secondary outcomes. Demographic characteristics, surgery characteristics, and primary outcomes between the groups were compared. Results A total of 120 eligible patients were recruited, including 40 in each group. Baseline and surgery characteristics between the groups were comparable (all p > 0.05). The PVB and RIB groups were better than the GA group in the primary and secondary outcomes (p < 0.05). The static VAS score, QoR15 score, and block-related complications within 48 hours after surgery were better in the RIB group than in the PVB group (p < 0.001). Conclusion Both PVB and RIB can provide adequate analgesia and accelerate the recovery of patients. Compared with PVB, RIB has a better analgesic effect, especially to avoid paravertebral pain caused by block, and the operation of RIB is more straightforward and the safety is higher.
Collapse
|
4
|
Kozanhan B, Yildiz M. When Exploring a Patient-Reported Outcome in Clinical Trial, Methodology Is an Important Issue. Ann Thorac Surg 2023; 115:290-291. [PMID: 35216992 DOI: 10.1016/j.athoracsur.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/08/2022] [Accepted: 02/12/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Betul Kozanhan
- Anesthesiology and Reanimation Clinic, Konya City Hospital, University of Health Sciences, Akabe, Adana Freeway St, No 135/1, Karatay, Konya, Turkey 42020.
| | - Munise Yildiz
- Anesthesiology and Reanimation Clinic, Konya City Hospital, University of Health Sciences, Akabe, Adana Freeway St, No 135/1, Karatay, Konya, Turkey 42020
| |
Collapse
|
5
|
Jaensson M, Nilsson U, Dahlberg K. Postoperative recovery: how and when is it assessed: a scoping review. Br J Anaesth 2022; 129:92-103. [PMID: 35623904 DOI: 10.1016/j.bja.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is no consensus about the type of instrument with which to assess postoperative recovery or the time points when assessments are most appropriate. It is also unclear whether instruments measure the four dimensions of postoperative recovery, that is physical, psychological, social, and habitual recovery. This scoping review had three objectives: (1) to identify and describe instruments used in clinical trials to assess postoperative recovery; (2) to determine how, when, and the number of times postoperative recovery was measured; and (3) to explore whether the four dimensions of postoperative recovery are represented in the identified instruments. METHODS A literature search was conducted in CINAHL, MEDLINE, and Web of Science. The search terms were related to three search strands: postoperative recovery, instrument, and clinical trials. The limits were English language and publication January 2010 to November 2021. In total, 5015 studies were identified. RESULTS A total of 198 studies were included in the results. We identified 20 instruments measuring postoperative recovery. Different versions of Quality of Recovery represented 81.8% of the included instruments. Postoperative recovery was often assessed at one time point (47.2%) and most often on postoperative day 1 (81.5%). Thirteen instruments had items covering all four dimensions of postoperative recovery. CONCLUSIONS Assessing recovery is important to evaluate and improve perioperative care. We emphasise the importance of choosing the right instrument for the concept studied and, if postoperative recovery is of interest, of assessing more than once. Ideally, instruments should include all four dimensions to cover the whole recovery process.
Collapse
Affiliation(s)
- Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| |
Collapse
|
6
|
Deng W, Jiang CW, Qian KJ, Liu F. Evaluation of Rhomboid Intercostal Block in Video-Assisted Thoracic Surgery: Comparing Three Concentrations of Ropivacaine. Front Pharmacol 2022; 12:774859. [PMID: 35115929 PMCID: PMC8805173 DOI: 10.3389/fphar.2021.774859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Ultrasound-guided rhombic intercostal block (RIB) is a novel regional block that provides analgesia for patients who have received video-assisted thoracoscopic surgery (VATS). The anesthetic characteristics of ultrasound-guided RIB with different concentrations of ropivacaine are not known. This research primarily hypothesizes that ultrasound-guided RIB, given in combination with the same volume of different concentrations of ropivacaine, would improve the whole quality of recovery-40 (QoR-40) among patients with VATS. Approaches: This double-blinded, single-center, prospective, and controlled trial randomized 100 patients undergoing VATS to receive RIB. One hundred patients who have received elective VATS and satisfied inclusion standards were fallen into four groups randomly: control group with no RIB and R0.2%, R0.3%, and R0.4%; they underwent common anesthesia plus the RIB with ropivacaine at 0.2%, 0.3%, and 0.4% in a volume of 30 ml. Outcomes: Groups R0.2%, R0.3%, and R0.4% displayed great diversities in the overall QoR-40 scores and QoR-40 dimensions (in addition to psychological support) by comparing with the control group (Group C) (p < 0.001 for all contrasts). Groups R0.3% and R0.4% displayed great diversities in the overall QoR-40 scores and QoR-40 dimensions (in addition to psychological support) by comparing with the R0.2% group (p < 0.001 for all contrasts). The overall QoR-40 scores and QoR-40 dimensions [physical comfort (p = 0.585)] did not vary greatly between Groups R0.3% and R0.4% (p > 0.05 for all contrasts). Groups R0.2%, R0.3%, and R0.4% showed significant differences in numerical rating scales (NRS) score region under the curve (AUC) at rest and on movement in 48 h when compared with the Group C (p < 0.001 for all contrasts). Groups R0.3% and R0.4% displayed great diversities in NRS score AUC at rest and on movement in 48 h when compared with the R0.2% group (p < 0.001 for all contrasts). The NRS mark AUC at rest and, on movement in 48 h, did not vary greatly between the Group R0.3% and R0.4% (p > 0.05 for all contrasts). Conclusion: In this study it was found that a dose of 0.3% ropivacaine is the best concentration for RIB for patients undergoing VATS. Through growing ropivacaine concentration, the analgesia of the RIB was not improved greatly. Clinicaltrials.gov Registration:https://clinicaltrials.gov/, identifier ChiCTR2100046254.
Collapse
Affiliation(s)
- Wei Deng
- Department of Critical Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Medical Innovation Center, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chen-Wei Jiang
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ke-Jian Qian
- Department of Critical Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Medical Innovation Center, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fen Liu
- Department of Critical Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Medical Innovation Center, First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
7
|
Zhang JG, Jiang CW, Deng W, Liu F, Wu XP. Comparison of Rhomboid Intercostal Block, Erector Spinae Plane Block, and Serratus Plane Block on Analgesia for Video-Assisted Thoracic Surgery: A Prospective, Randomized, Controlled Trial. Int J Clin Pract 2022; 2022:6924489. [PMID: 35832798 PMCID: PMC9246596 DOI: 10.1155/2022/6924489] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/08/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Thoracic surgery is one of the most painful surgical steps. An important tool for managing postoperative pain is effective postoperative analgesia. This research aimed at comparing the analgesic roles of three new fascial block techniques in the postoperative period after video-helped thoracoscopic operation (VATS). METHODS We randomly allocated ninety patients into three teams experiencing ultrasound-directed serratus plane block, erector spinae plane block, and the rhomboid intercostal block, respectively. 0.4% ropivacaine of 20 mL was received by all groups. Outcomes. At 0-12 hours, sufentanil consumption was significantly lower in the RIB (35.2 ± 3.3 mg) and ESP (35.4 ± 2.8 mg) groups than that in the SAB (43.3 ± 2.7 mg) group (P < 0.001), and no obvious diversity in sufentanil consumption was shown between the RIB and ESP groups (P=0.813). At 12-24 hours, sufentanil consumption was greatly lower in the RIB and ESP groups than that in the SAB group (P < 0.001), and no great diversity in sufentanil consumption was found between the RIB and ESP groups (P=0.589). No great diversity in sufentanil consumption was shown between the RIB (50.4 ± 1.4 mg), ESP (50.4 ± 1.5 mg), and SAB (51.0 ± 1.7 mg) groups at 24-48 hours (P=0.192). At 6, 12, 18, and 24 hours, the postoperative dynamic NRS scores were significantly lower in the RIB and ESP groups than in the SAB group ((P < 0.05) for all contrasts). Nevertheless, no great diversity was observed in postoperative pain marks at 0.5, 1, 3, 6, 12, 18, 24, 36, and 48 hours after the surgery across the three groups. No statistical diversity was found in the postoperative NRS mark between groups RIB and ESP within 48 hours after surgery in case of active patients ((P < 0.05) for all contrasts). At 24 hours after surgery, a significant difference in IL-1β and IL-6 inflammatory factor concentrations was found between RIB and ESP compared with SAB block ((P < 0.05) for all contrasts). However, no great diversities were observed in IL-1β, and IL-6 inflammatory factor concentrations between RIB, ESP, and SAB at 24 hours preoperatively and at 48 hours postoperatively ((P < 0.05) for all comparisons). CONCLUSION The dosage of sufentanil can be effectively reduced by ultrasound-directed rhomboid intercostal block and erector spinae plane block within 24 hours after VATS surgery, and pain can be relieved effectively within 24 hours by comparing with serratus plane block.
Collapse
Affiliation(s)
- Jian-Guo Zhang
- Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Departments of Critical Care Medicine, Linyi People's Hospital, Linyi, Shandong, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chen-Wei Jiang
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Wei Deng
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Fen Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiao-Ping Wu
- Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|