Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures

Steven E. Hill, Rebecca A. Keller, Mark Stafford-Smith, Katherine Grichnik, William D. White, Thomas A. D'Amico, Mark F. Newman

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background: Although video-assisted thoracoscopic surgery for pulmonary resection is increasingly chosen over thoracotomy, the optimal analgesia regimen for thoracoscopy is unknown. The purpose of this trial was to compare the efficacy of analgesia from preoperative bupivacaine paravertebral nerve blockade with that from placebo injections. Methods: Eighty adult patients undergoing unilateral thoracoscopic procedures were enrolled in a prospective, double-blinded, randomized clinical trial of preoperative, multilevel, single-dose paravertebral nerve blockade. Patients received six paravertebral injections with 5 ml of either 0.5% bupivacaine with 0.0005% epinephrine (treated, n = 40) or preservative-free saline (control, n = 40). Cumulative weight-adjusted intraoperative fentanyl and postoperative patient-controlled morphine usage, visual analog pain scores, and spirometry were used to compare efficacy of analgesia between groups. Results: The treated group received significantly less intraoperative fentanyl compared with the control group (P = 0.003) and had a 31% smaller cumulative patient-controlled morphine dose (P = 0.03) in the 6 h after block placement. Within 6 h, treated patients also reported lower maximum pain scores (P = 0.02) and demonstrated less pain score variability (P = 0.01). No statistically significant difference in cumulative morphine usage existed at 12 or 18 h after block placement. No significant difference in spirometry, cortisol levels, or cytokine production was found between treatments. Conclusions: Single-dose paravertebral nerve blockade with bupivacaine is effective in reducing pain after thoracoscopic surgery, but only during the first 6 h after nerve blockade. Because of the limited duration of effect with currently available local anesthetic agents, the current data suggest that, at present, this technique is not indicated in the setting of thoracoscopic surgery.

Original languageEnglish (US)
Pages (from-to)1047-1053
Number of pages7
JournalAnesthesiology
Volume104
Issue number5
DOIs
StatePublished - May 2006

Fingerprint

Nerve Block
Analgesia
Thoracoscopy
Bupivacaine
Morphine
Pain
Spirometry
Fentanyl
Video-Assisted Thoracic Surgery
Injections
Thoracotomy
Local Anesthetics
Epinephrine
Anesthetics
Hydrocortisone
Randomized Controlled Trials
Placebos
Cytokines
Weights and Measures
Lung

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Hill, S. E., Keller, R. A., Stafford-Smith, M., Grichnik, K., White, W. D., D'Amico, T. A., & Newman, M. F. (2006). Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. Anesthesiology, 104(5), 1047-1053. https://doi.org/10.1097/00000542-200605000-00022

Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. / Hill, Steven E.; Keller, Rebecca A.; Stafford-Smith, Mark; Grichnik, Katherine; White, William D.; D'Amico, Thomas A.; Newman, Mark F.

In: Anesthesiology, Vol. 104, No. 5, 05.2006, p. 1047-1053.

Research output: Contribution to journalArticle

Hill, SE, Keller, RA, Stafford-Smith, M, Grichnik, K, White, WD, D'Amico, TA & Newman, MF 2006, 'Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures', Anesthesiology, vol. 104, no. 5, pp. 1047-1053. https://doi.org/10.1097/00000542-200605000-00022
Hill, Steven E. ; Keller, Rebecca A. ; Stafford-Smith, Mark ; Grichnik, Katherine ; White, William D. ; D'Amico, Thomas A. ; Newman, Mark F. / Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. In: Anesthesiology. 2006 ; Vol. 104, No. 5. pp. 1047-1053.
@article{b1a5dd8018ae4e92996bea2da5fe5ca3,
title = "Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures",
abstract = "Background: Although video-assisted thoracoscopic surgery for pulmonary resection is increasingly chosen over thoracotomy, the optimal analgesia regimen for thoracoscopy is unknown. The purpose of this trial was to compare the efficacy of analgesia from preoperative bupivacaine paravertebral nerve blockade with that from placebo injections. Methods: Eighty adult patients undergoing unilateral thoracoscopic procedures were enrolled in a prospective, double-blinded, randomized clinical trial of preoperative, multilevel, single-dose paravertebral nerve blockade. Patients received six paravertebral injections with 5 ml of either 0.5{\%} bupivacaine with 0.0005{\%} epinephrine (treated, n = 40) or preservative-free saline (control, n = 40). Cumulative weight-adjusted intraoperative fentanyl and postoperative patient-controlled morphine usage, visual analog pain scores, and spirometry were used to compare efficacy of analgesia between groups. Results: The treated group received significantly less intraoperative fentanyl compared with the control group (P = 0.003) and had a 31{\%} smaller cumulative patient-controlled morphine dose (P = 0.03) in the 6 h after block placement. Within 6 h, treated patients also reported lower maximum pain scores (P = 0.02) and demonstrated less pain score variability (P = 0.01). No statistically significant difference in cumulative morphine usage existed at 12 or 18 h after block placement. No significant difference in spirometry, cortisol levels, or cytokine production was found between treatments. Conclusions: Single-dose paravertebral nerve blockade with bupivacaine is effective in reducing pain after thoracoscopic surgery, but only during the first 6 h after nerve blockade. Because of the limited duration of effect with currently available local anesthetic agents, the current data suggest that, at present, this technique is not indicated in the setting of thoracoscopic surgery.",
author = "Hill, {Steven E.} and Keller, {Rebecca A.} and Mark Stafford-Smith and Katherine Grichnik and White, {William D.} and D'Amico, {Thomas A.} and Newman, {Mark F.}",
year = "2006",
month = "5",
doi = "10.1097/00000542-200605000-00022",
language = "English (US)",
volume = "104",
pages = "1047--1053",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures

AU - Hill, Steven E.

AU - Keller, Rebecca A.

AU - Stafford-Smith, Mark

AU - Grichnik, Katherine

AU - White, William D.

AU - D'Amico, Thomas A.

AU - Newman, Mark F.

PY - 2006/5

Y1 - 2006/5

N2 - Background: Although video-assisted thoracoscopic surgery for pulmonary resection is increasingly chosen over thoracotomy, the optimal analgesia regimen for thoracoscopy is unknown. The purpose of this trial was to compare the efficacy of analgesia from preoperative bupivacaine paravertebral nerve blockade with that from placebo injections. Methods: Eighty adult patients undergoing unilateral thoracoscopic procedures were enrolled in a prospective, double-blinded, randomized clinical trial of preoperative, multilevel, single-dose paravertebral nerve blockade. Patients received six paravertebral injections with 5 ml of either 0.5% bupivacaine with 0.0005% epinephrine (treated, n = 40) or preservative-free saline (control, n = 40). Cumulative weight-adjusted intraoperative fentanyl and postoperative patient-controlled morphine usage, visual analog pain scores, and spirometry were used to compare efficacy of analgesia between groups. Results: The treated group received significantly less intraoperative fentanyl compared with the control group (P = 0.003) and had a 31% smaller cumulative patient-controlled morphine dose (P = 0.03) in the 6 h after block placement. Within 6 h, treated patients also reported lower maximum pain scores (P = 0.02) and demonstrated less pain score variability (P = 0.01). No statistically significant difference in cumulative morphine usage existed at 12 or 18 h after block placement. No significant difference in spirometry, cortisol levels, or cytokine production was found between treatments. Conclusions: Single-dose paravertebral nerve blockade with bupivacaine is effective in reducing pain after thoracoscopic surgery, but only during the first 6 h after nerve blockade. Because of the limited duration of effect with currently available local anesthetic agents, the current data suggest that, at present, this technique is not indicated in the setting of thoracoscopic surgery.

AB - Background: Although video-assisted thoracoscopic surgery for pulmonary resection is increasingly chosen over thoracotomy, the optimal analgesia regimen for thoracoscopy is unknown. The purpose of this trial was to compare the efficacy of analgesia from preoperative bupivacaine paravertebral nerve blockade with that from placebo injections. Methods: Eighty adult patients undergoing unilateral thoracoscopic procedures were enrolled in a prospective, double-blinded, randomized clinical trial of preoperative, multilevel, single-dose paravertebral nerve blockade. Patients received six paravertebral injections with 5 ml of either 0.5% bupivacaine with 0.0005% epinephrine (treated, n = 40) or preservative-free saline (control, n = 40). Cumulative weight-adjusted intraoperative fentanyl and postoperative patient-controlled morphine usage, visual analog pain scores, and spirometry were used to compare efficacy of analgesia between groups. Results: The treated group received significantly less intraoperative fentanyl compared with the control group (P = 0.003) and had a 31% smaller cumulative patient-controlled morphine dose (P = 0.03) in the 6 h after block placement. Within 6 h, treated patients also reported lower maximum pain scores (P = 0.02) and demonstrated less pain score variability (P = 0.01). No statistically significant difference in cumulative morphine usage existed at 12 or 18 h after block placement. No significant difference in spirometry, cortisol levels, or cytokine production was found between treatments. Conclusions: Single-dose paravertebral nerve blockade with bupivacaine is effective in reducing pain after thoracoscopic surgery, but only during the first 6 h after nerve blockade. Because of the limited duration of effect with currently available local anesthetic agents, the current data suggest that, at present, this technique is not indicated in the setting of thoracoscopic surgery.

UR - http://www.scopus.com/inward/record.url?scp=33646818026&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646818026&partnerID=8YFLogxK

U2 - 10.1097/00000542-200605000-00022

DO - 10.1097/00000542-200605000-00022

M3 - Article

C2 - 16645458

AN - SCOPUS:33646818026

VL - 104

SP - 1047

EP - 1053

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 5

ER -