The study was to determine the analgesic effect of ultrasound-guided intercostal nerve block (ICNB) and single-injection erector spinae plane block (ESPB) in comparison with multiple-injection ...paravertebral block (PVB) after thoracoscopic surgery.
Randomized, controlled, double- blinded study.
Operating room, postoperative recovery room and ward.
Seventy-five patients, aged 18–75 years, ASA I–II and scheduled for elective thoracoscopic partial pulmonary resection surgery were enrolled in the study. Seventy-two patients were left for final analysis.
Patients were randomly assigned into the three groups (PVB group, ICNB group or ESPB group). After anesthesia induction, a single anesthesiologist performed PVB at T5-T7 levels or ICNB at T4-T9 levels or ESPB at T5 level under ultrasound guidance using 20 ml of 0.375% ropivacaine. Patients were connected to the patient-controlled morphine analgesia device after surgery.
Cumulative morphine consumption at 24 h postoperatively as primary outcome was compared. Visual analog scale pain scores at rest and while coughing at 0, 2, 4, 8, 24 and 48 h postoperatively, cumulative morphine consumption at other observed time and rescue analgesia requirement were also recorded.
There was a significant difference in median interquartile range, IQR morphine consumption at 24 h postoperatively among the three groups (PVB, 10.5 9–15 mg; ICNB, 18 13.5–22.1 mg; ESPB, 22 15–25.1 mg; p = 0.000). This difference was statistically significant for PVB group vs ESPB group (median difference, −7.5; 95% confidence interval CI, −12 to −4.5; p = 0.000) and PVB group vs ICNB group (median difference, −6; 95% CI, −9 to −3; p = 0.001), but not for ICNB vs ESPB (median difference, −3; 95% CI, −6 to 1.5; p = 0.192). PVB group had significantly lower VAS scores at rest and while coughing than ESPB group at 0, 2, 4, 8 h postoperatively and than ICNB group at 8 h postoperatively. There was no significant difference in the VAS scores between ICNB group and ESPB group at all time. Median VAS scores at rest and while coughing at all time were low (<4) in all groups. More rescue analgesia was needed in ESPB group during 48 postoperative hours (PVB vs ICNB vs ESPB; 13% vs 29% vs 46%; p < 0.05).
Ultrasound-guided multiple-injection PVB provided superior analgesia to ICNB and single-injection ESPB, while ICNB and single-injection ESPB were equally effective in reducing pain after thoracoscopic surgery.
•PVB provided superior postoperative analgesia in VATS to ICNB and ESPB.•ICNB and ESPB were equally effective in reducing pain after VATS.•ESPB is technically safer and easier than PVB and ICNB.
The objective of this study was to compare analgesic efficacy of erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), and intercostal nerve block (ICNB) after video-assisted ...thoracoscopic surgery (VATS).
Prospective, randomized, single-blind study.
University hospital, single institution.
Adult patients undergoing VATS.
Ultrasonography-guided ESPB, ultrasonography-guided TPVB, or ICNB.
Patients were enrolled into the following three groups according to analgesia technique as ESPB, TPVB, or ICNB, respectively, group erector spinae plane block (GESP) (n = 35), group thoracic paravertebral block (GTPV) (n = 35), and group intercostal nerve block (GICN) (n = 36). Multimodal analgesia was achieved with paracetamol, tenoxicam, and intravenous morphine (via patient-controlled analgesia) for all study groups. Pain scores were assessed by visual analog scale, and morphine consumption, rescue analgesic requirement, and side effects were recorded postoperatively. Dynamic visual analog scale at the first hour as primary outcome was determined five (two-seven), four (one-six) and (two-six) in GESP, GTPV, and GICN, respectively. Dynamic pain scores were significantly lower in GTPV compared with GESP and GICN at 24 hours (p < 0.017). Dynamic pain scores in GICN were significantly lower at 12 hours compared with GESP (p < 0.017). Morphine consumption for the first 24 hours was similar in GICN and GTPV, and it was significantly lower in GICN and GTPV in comparison to GESP (p < 0.017). Rescue analgesic requirement and side effects were similar among groups.
All three blocks can obtain sufficient analgesia after VATS; however, TPVB appeared to be the preferable method compared with ESPB and ICNB, with a more successful analgesia and less morphine consumption.
The aim of this study was to compare the relative efficacy of ultrasound-guided serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for the ...management of post-thoracotomy pain in pediatric cardiac surgery.
A prospective, randomized, single-blind, comparative study.
Single-institution tertiary referral cardiac center.
The study comprised 108 children with congenital heart disease requiring surgery through a thoracotomy.
Children were allocated randomly to 1 of the 3 groups: SAPB, Pecs II, or ICNB. All participants received 3 mg/kg of 0.2% ropivacaine for ultrasound-guided block after induction of anesthesia. Postoperatively, intravenous paracetamol was used for multimodal and fentanyl was used for rescue analgesia.
A modified objective pain score (MOPS) was evaluated at 1, 2, 4, 6, 8, 10, and 12 hours post-extubation. The early mean MOPS at 1, 2, and 4 hours was similar in the 3 groups. The late mean MOPS was significantly lower in the SAPB group compared with that of the ICNB group (p < 0.001). The Pecs II group also had a lower MOPS compared with the ICNB group at 6, 8, and 10 hours (p < 0.001), but the MOPS was comparable at hour 12 (p = 0.301). The requirement for rescue fentanyl was significantly higher in ICNB group in contrast to the SAPB and Pecs II groups.
SAPB and Pecs II fascial plane blocks are equally efficacious in post-thoracotomy pain management compared with ICNB, but they have the additional benefit of being longer lasting and are as easily performed as the traditional ICNB.
To observe the effect of ropivacaine intercostal nerve block combined with PCIA as early postoperative analgesia following breast augmentation surgery with prosthesis (axillary approach) METHODS: A ...total of 80 women with breast augmentation surgery were selected in the plastic surgery department of Chongqing Huamei Plastic Surgery Hospital from December 2021 to May 2022. They were equally randomized into control group and observation group, with 40 cases in each one. Before placing the prosthesis, the control group was given 0.9% normal saline for intercostal nerve block; the observation group was given 0.75% ropivacaine + 1‰ adrenaline for intercostal nerve block. Patient controlled intravenous analgesia (PCIA) was used after operation. Observation indexes the visual analog scale (VAS) of resting and motor state at 4 h, 24 h, 48 h and 72 h after operation and the adverse reactions.
The VAS scores of patients at rest and exercise and adverse reactions in the observation group were lower than those in the control group (P<0.05).
Ropivacaine intercostal nerve block combined with PCIA can effectively alleviate the pain after breast augmentation with pectoralis major prosthesis through axillary incision, help patients more comfortably through the perioperative period, accelerate postoperative recovery, reduce the dosage of systemic opioids and effectively reduce side effects.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
We read the recently published article "Effect of Ropivacaine Intercostal Nerve Block Combined with Patient Controlled Intravenous Analgesia on Postoperative Analgesia after Breast Augmentation" by ...You et al. We have noticed several issues in the methods and results of this study and would appreciate the responses from the authors. We question several aspects, opioid-sparing effect, sufentanil consumption, sample size evaluation, exclusion reasons, and side effects.
Pain associated with chest wall trauma is a major issue in the emergency department (ED). However, it may be challenging to select among the various analgesic procedures.
Our aim was to compare ...single-shot erector spinae plane block (ESPB) with intercostal nerve block (ICNB) under ultrasound guidance for pain management in thoracic trauma.
This study was a randomized nonblinded clinical trial performed in a level I urban trauma center. A convenience sample of patients with isolated chest wall trauma and initial Numeric Rating Scale pain scores (NRS 0) > 5 were included. Exclusion criteria were large pain area, surgical interventions, discharged from the ED, and presence of contraindications to lidocaine. Pain scores at 20 min and 60 min (NRS 20 and 60) and at disposition (disp) were recorded.
Twenty-seven patients in the ESPB and 23 in the ICNB groups were enrolled. Mean values of NRS 0, 20, 60, and disp for the ESPB vs. ICNB groups were 8.0 vs. 7.4, 5.2 vs. 6.1, 4.1 vs. 5.4, and 4.3 vs. 5.8, respectively (p = 0.07, p = 0.04, p = 0.001, and p < 0.001, respectively). Four patients in the ESPB and 8 patients in the ICNB groups required administration of adjunctive doses of fentanyl for satisfactory pain control (p = 0.09).
Ultrasound-guided ESPB was superior to ICNB regarding pain control during the ED stay period of patients with painful chest wall trauma. We recommend ESPB in the ED for pain control in blunt or penetrating thoracic trauma.
Postoperative analgesia is crucial after video-assisted thoracoscopic surgery (VATS). This study was designed to investigate whether the analgesic effect of programmed intermittent bolus (PIB) ...erector spinae plane block (ESPB) is noninferior to that of intercostal nerve block with patient-controlled intravenous analgesia (ICNB-PCIA) for VATS.
The study was a single-center, open labeled, randomized noninferiority trial. A total of 80 patients (American Society of Anesthesiologists I to III) undergoing elective video-assisted thoracoscopic lobectomy or bulla resection were randomly allocated to the ICNB-PCIA (n=40) or the ESPB (n=40) group using a PIB injection. The primary outcome was pain intensity at movement at 4 hours postoperatively using the Numeric Rating Scale (NRS). Secondary outcomes included pain scores at rest and movement in the recovery room, at 8, 24, and 48 hours postoperatively, perioperative analgesics, adverse effects, hospital stay, and patient satisfaction.
The mean difference in NRS scores at movement at 4 hours postoperatively between the ESPB (n=39) and the ICNB-PCIA (n=37) groups was under the noninferiority margin. NRS scores were significantly higher in the ICNB-PCIA group than the ESPB group at movement postoperatively. At rest, NRS scores were significantly elevated in the ICNB-PCIA at 4, 8, and 24 hours. The postoperative opioids consumption was decreased in the ESPB group. No difference was found in rescue analgesics, hospital stay, and patient satisfaction.
ESPB using a PIB injection offers noninferior analgesia to ICNB-PCIA after VATS.
Introduction:
The analgesic efficacy of erector spinae plane block (ESPB) versus intercostal nerve block (ICNB) for thoracoscopic surgery remains controversial. We conducted a systematic review and ...meta-analysis to explore the impact of ESPB versus ICNB on thoracoscopic surgery.
Methods:
We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane library databases through May 2023 for randomized controlled trials (RCTs) assessing the effect of ESPB versus ICNB on thoracoscopic surgery. This meta-analysis was performed using the random-effect model or fixed-effect model based on the heterogeneity.
Results:
Four RCTs and 203 patients are included in the meta-analysis. Overall, compared with ICNB for thoracoscopic surgery, ESPB results in significantly reduced pain scores at 48 hours (SMD standard mean difference = −3.49; 95% CI confidence interval = −6.76 to −0.21;
P
= .04), but demonstrated no impact on pain scores at 24 hours (SMD = −0.04; 95% CI = −1.24 to 1.16;
P
= .95), pain scores at 4 to 6 hours (SMD = −0.16; 95% CI = −2.02 to 1.71;
P
= .87), pain scores at 12 hours (SMD = −0.16; 95% CI = −2.38 to 2.05;
P
= .88) or analgesic consumption (SMD = 0.27; 95% CI = −0.80 to 1.35;
P
= .62).
Conclusions:
ESPB may be comparable with ICNB for the postoperative pain control of thoracoscopic surgery.
Our aim was to evaluate the efficacy and safety of multimodal cocktail intercostal injection for the relief of chest pain after costal cartilage harvest for rhinoplasty.
Consecutive patients who ...underwent costal cartilage harvest during rhinoplasty were prospectively assigned as per patient preference to group A (injection containing ropivacaine, parecoxib sodium, epinephrine, and compound betamethasone), group B (intercostal nerve block (ICNB)), or group C (ICNB plus patient-controlled analgesia (PCA)). The outcomes were visual analogue scale (VAS) scores for chest pain after costal cartilage harvest, rescue analgesia, complications, and cost during the first two days. Of the 66 patients assessed, 63 (29 patients in group A, 13 in group B, and 21 in group C) were eligible and included. The VAS scores in group A were significantly lower than those in groups B and C (all p<0.001). Group A had a significantly lower rate of rescue analgesia due to a VAS score of more than 4 (3.45%, 1/29) compared with group B (46.15%, 6/13; p=0.001) and group C (28.57%, 6/21; p=0.012). Complications were observed only in group C (nausea/vomiting 28.57%; dizziness/headache 23.81%), which differed significantly from group A (p=0.002 and 0.006, respectively). The mean cost for group A (US $15 (0)) was significantly lower than it was for group C (US $113.1 (4.4), p<0.05), but higher than it was for group B (US $5.97 (0), p= -). Multimodal cocktail intercostal injection may be superior for chest pain relief after costal cartilage harvest for rhinoplasty compared with ICNB with or without PCA. Further study is warranted.
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