scholarly journals Single shot ultrasound-guided thoracic paravertebral block for opioid-free radical mastectomy: a prospective observational study

2019 ◽  
Vol Volume 12 ◽  
pp. 2701-2708 ◽  
Author(s):  
Domenico P Santonastaso ◽  
Annabella de Chiara ◽  
Emanuele Russo ◽  
Giovanni Musetti ◽  
Leonardo Lucchi ◽  
...  
Keyword(s):  
Free Radical ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Radical Mastectomy ◽  
Paravertebral Block ◽  
Single Shot ◽  
Ultrasound Guided ◽  
Thoracic Paravertebral Block

A possible future for anaesthesia in breast surgery: thoracic paravertebral block and awake surgery. A prospective observational study

2020 ◽  
pp. 030089162095162
Author(s):  
Domenico P. Santonastaso ◽  
Annabella de Chiara ◽  
Emanuele Russo ◽  
Emiliano Gamberini ◽  
Leonardo Lucchi ◽  
...  
Keyword(s):  
Observational Study ◽  
General Anaesthesia ◽  
Prospective Observational Study ◽  
Rating Scale ◽  
Breast Surgery ◽  
Numeric Rating Scale ◽  
Paravertebral Block ◽  
Awake Surgery ◽  
Thoracic Paravertebral Block ◽  
Numeric Rating

Introduction: Quadrantectomy is a surgical procedure traditionally performed under general anaesthesia with intraoperative and postoperative opioid-based analgesia. The use of locoregional anaesthesia techniques in breast surgery has become widespread and allows excellent management of intraoperative and postoperative pain with reduced opioid consumption. We chose thoracic paravertebral block as regional anaesthesia technique in breast surgery to investigate the possibility of carrying out this surgery with the patient awake. Methods: A prospective observational study on 50 patients was designed. The primary outcome for this study was the possibility to carry out the surgery with only the paravertebral block associated with mild sedation without general anaesthesia. Forty minutes before the start of the surgery, an ultrasound-guided thoracic paravertebral block was performed at two thoracic levels, and for each level, 7 mL of ropivacaine 0.7% was injected. Sedation was obtained with target-controlled infusion of propofol. Results: Forty-nine patients underwent the operation awake; in one case, we had to place an I-gel and perform general anaesthesia. No patient needed intraoperative or postoperative opioids. The numeric rating scale, recorded at 0, 2, 6, 12, 24, and 36 hours, was greater than 3 in only five patients. Conclusions: We believe that if in the future we try to make quadrantectomy an intervention in which the anaesthesia is exclusively regional, therefore with a patient awake and collaborating, it will not be possible to ignore the use of thoracic paravertebral block.

scholarly journals Infrared thermography for assessment of thoracic paravertebral block: a prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuang Zhang ◽  
Yong Liu ◽  
Xiaohu Liu ◽  
Tianzhu Liu ◽  
Pengcheng Li ◽  
...  
Keyword(s):  
Observational Study ◽  
Skin Temperature ◽  
Infrared Thermography ◽  
Roc Curve ◽  
Prospective Observational Study ◽  
Thoracoscopic Surgery ◽  
Paravertebral Block ◽  
Trial Registration ◽  
Roc Curve Analysis ◽  
Thoracic Paravertebral Block

Abstract Background There was no “gold standard” to assess the success or failure of thoracic paravertebral block (TPVB). Measurement of skin temperature with infrared thermography (IT) would be a reliable method to evaluate the effectiveness of regional blocks. This study aimed to explore the feasibility of using skin temperature difference (Td) determined by IT between the blocked and unblocked side to predict the spread of TPVB. Methods Sixty-one patients undergoing elective unilateral breast or thoracoscopic surgery were enrolled in this prospective observational study. TPVB was performed at T4 and T5 under real-time ultrasound guidance with 10 mL of 0.4% ropivacaine for each patient, respectively. Td between the blocked and unblocked side were measured with IT from T2 to T10 at the anterior chest wall before TPVB and 5 min, 10 min, 15 min and 20 min after TPVB. Pinprick test was performed at 20 min after TPVB. Successful TPVB was defined as no sensation to pinprick in 3 or more adjacent dermatomes corresponding to the site of injection at 20 min after TPVB. Td was compared to pinprick test for evaluating its effectiveness in predicting the success of TPVB. The sensitivity, specificity, and cut-off value of Td for predicting successful TPVB were determined by receiver operator characteristic (ROC) curve analysis. Results Compared with the baseline value before block, Td from T2 to T10 were significantly increased at each time point in successful blocks. In failed blocks, Td was not increased in any dermatome. The increase of Td at T4-T7 was more than 1 °C 20 min after successful TPVB. Fifteen minutes after block, Td increase at T4 had the greatest potential to predict block success. The area under the ROC curve was 0.960 at a cut-off value of 0.63 °C with a sensitivity of 83.3% and a specificity of 100.0%. Conclusions This study suggested that the increase of Td at T4 dermatome determined by IT between the blocked and unblocked side is an early, quantitative, and reliable predictor of successful TPVB. Trial registration Clinical trial registration: NCT04078347.

scholarly journals Infrared Thermography for Assessment of Thoracic Paravertebral Block: A Prospective Observational Study

2021 ◽  
Author(s):  
Shuang Zhang ◽  
Yong Liu ◽  
Xiaohu Liu ◽  
Tianzhu Liu ◽  
Pengcheng Li ◽  
...  
Keyword(s):  
Observational Study ◽  
Skin Temperature ◽  
Infrared Thermography ◽  
Roc Curve ◽  
Prospective Observational Study ◽  
Thoracoscopic Surgery ◽  
Paravertebral Block ◽  
Roc Curve Analysis ◽  
Clinical Trial Registration ◽  
Thoracic Paravertebral Block

Abstract Background: There was no “gold standard” to assess the success or failure of thoracic paravertebral block (TPVB). Measurement of skin temperature with infrared thermography (IT) would be a reliable method to evaluate the effectiveness of regional blocks. This study aimed to explore the feasibility of using skin temperature difference (Td) determined by IT between the blocked and unblocked side to predict the outcome of TPVB. Methods: Sixty-one patients undergoing elective unilateral breast or thoracoscopic surgery were enrolled in this prospective observational study. TPVB was performed at T4 and T5 under real-time ultrasound guidance with 10 mL of 0.4% ropivacaine for each patient, respectively. Td between the blocked and unblocked side were measured with IT from T2 to T10 at the anterior chest wall before TPVB and 5 min, 10 min, 15 min and 20 min after TPVB. Pinprick test was performed at 20 min after TPVB. Successful TPVB was defined as no sensation to pinprick in 3 or more adjacent dermatomes corresponding to the site of injection at 20 min after TPVB. Td was compared to pinprick test for evaluating its effectiveness in predicting the success of TPVB. The sensitivity, specificity, and cut-off value of Td for predicting successful TPVB were determined by receiver operator characteristic (ROC) curve analysis.Results: Compared with the baseline value before block, Td from T2 to T10 were significantly increased at each time point in successful blocks. In failed blocks, Td was not increased in any dermatome. The increase of Td at T4-T7 was more than 1℃ 20 min after successful TPVB. Fifteen minutes after block, Td increase at T4 had the greatest potential to predict block success. The area under the ROC curve was 0.960 at a cut-off value of 0.63℃ with a sensitivity of 83.3% and a specificity of 100.0%.Conclusions: This study suggested that the increase of Td at T4 dermatome determined by IT between the blocked and unblocked side is an early, quantitative, and reliable predictor of successful TPVB. Clinical trial registration: NCT04078347

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