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BACKGROUND: Current studies have shown that ultrasound-guided paravertebrospinai nerve block widely used has a significant effect in the clinical treatment of thoracolumbar zoster-associated pain. OBJECTIVE: To systematically evaluate the efficacy and safety of ultrasound-guided paravertebral nerve block in the treatment of thoracolumbar zoster-associated pain and to provide reference for clinical treatment. METHODS: We searched relevant literature in PubMed, The Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database (VIP) and Chinese Biomedical Literature Database (CBM). The limit of searching time was from inception until January 1, 2019. Randomized controlled trials addressing ultrasound-guided paravertebral nerve block (experimental group) versus drug therapy (control group) for the treatment of acute zoster-associated pain or postherpetic neuralgia were collected according to the criteria for inclusion and exclusion. Literature quality was assessed according to Cochrane Handbook 5.1.0 bias risk assessment tool. The literature data were analyzed using Revman 5.3 software through a Meta-analysis. RESULTS AND CONCLUSION: A total of 11 randomized controlled trials involving 916 patients met the inclusion criteria. The results of Meta-analysis showed that compared with the control group, the ultrasound-guided paravertebral nerve block group had better analgesic effect and the optimal analgesic effect appeared within 1-4 weeks. A random effects model was then used [1st week: Mean difference (MD)=-0.91, 95% confidence interval (Cl) (-1.22, -0.61), P < 0.000 01; 2nd week: MD=-1.11, 95%C/(-1.52, -0.70), P < 0.000 01; 3rd week: MD=-1.26, 95%C/(-1.79, -0.74), P < 0.000 01; 4th week: MD=-0.90, 95%C/(-1.57, -0.24), P=0.007], At the same time, the quality of sleep and the effective rate of treatment were improved, and a fixed effects model was used [odds ratio=3.63, 95%C/(2.38, 5.53), P < 0.000 01]. The statistical results showed significant difference. There was no increase in post-treatment adverse reactions. Therefore, ultrasound-guided paravertebral nerve block is safe and effective for the treatment of zoster-associated pain in the thoracolumbar region.
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Objective To investigate the analgesic effect of ultrasound-guided paravertebral nerve block on patients with radical mastectomy. Methods Sixty female patients who underwent unilateral radical mastectomy with general anesthesia in the Second Hospital of Shanxi Medical University from March 2016 to January 2018 were enrolled, and 58 cases were actually studied according to the inclusion and exclusion criteria. According to the random number table method, the patients were randomly divided into simple general anesthesia group (GA group, 30 cases) and paravertebral nerve block combined with general anesthesia group (PG group, 28 cases). In the PG group, 15 ml of 0.4％ ropivacaine was injected into the T2-T6 paraspinal space on the surgical side with ultrasound. All patients received general anesthesia with intravenous propofol induction, and were given a self-controlled intravenous analgesia pump. When the visual analogue scale (VAS) score was ≥7 points, the patient was given intravenous morphine 5-10 mg. The t-test andχ2 test were used to compare the hemodynamic parameters at different time points, the VAS score at different time after operation, the postoperative analgesia pump use, and postoperative adverse reactions. Results There were no significant differences in hemodynamic parameters between the PG group and the GA group at different times (all P>0.05). The static VAS scores of the PG group at different time points were lower than those of the GA group, but the difference was not statistically significant (all P> 0.05). The cough dynamic VAS scores of the patients in the PG group were lower than those in the GA group at 2, 6, 12, and 24 h after surgery, and the difference was statistically significant (all P<0.05). The total amount of sufentanil [(35±10)μg vs. (50±8) μg, t=6.308, P<0.05], the number of remedial analgesia within 48 hours after operation [(550±105) mg vs. (680±128) mg, t=4.240, P<0.05], and the number of effective presses of analgesia pump (3.1±1.5 vs. 10.0± 3.4, t=10.117, P<0.05) in the PG group were significantly lower than those in the GA group. The adverse reactions such as nausea, vomiting and lethargy in the PG group were significantly lower than those in the GA group, and the difference was statistically significant (χ2 values were 3.869 and 2.334, both P< 0.05). The postoperative analgesia comfort rate of the PG group was significantly higher than that of the GA group [96.4％(27/28) vs. 70.0％(21/30)], and the difference was statistically significant (χ2=7.089, P<0.05). Conclusion The combined use of general anesthesia and ultrasound-guided paravertebral nerve block for postoperative analgesia in patients with radical mastectomy is superior to PCIA.
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Objective To compare the efficacy and safety of ultrasound guided pectoral nerves Ⅱ (Pecs Ⅱ) block with thoracic paravertebral nerve (TPVN) block for postoperative analgesia after modified radical mastectomy.Methods Eighty female patients scheduled for radical mastectomy,aged 40-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups using a random number table method (n =40 each):the patients in group T received TPVN block,whereas the pa tients in group P received Pecs Ⅱ block.Both the groups received 0.5 ％ ropivacaine 25 ml.The blocks were performed under all aseptic precautions in the preoperating room 30 min before surgery.The total number of dermatomes that had less pain to pin prick compared with opposite side were not ed.All patients were observed for 30 min after performing the block.The patients were received patient-controlled intravenous analgesia (PCIA).The duration of analgesia and total analgesic consumption in 24 h after surgery were recorded.Adverse effects were recorded between the two groups.Results The duration of analgesia in group P was significantly prolonged than group T [(326.5± 47.8) min vs (201.4±34.5) min,P＜0.01].The 24 h sufentanil consumption were also decreased in group P [(6.9±1.2) μg vs (10.7±1.9) μg,P＜0.01].T2 dermatomal spread were significantly increased in group P [35 (87.6％) cases vs 9 (22.5％) cases,P＜0.05].No complication was recor ded.Conclusion Ultrasound-guided Pecs Ⅱ block and TPVN provided safe and effective anesthesia in patients undergoing modified radical mastectomy,but the effect of Pecs Ⅱ block were more satisfied and per sistent.
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Objective To compare the anesthetic effect of ultra-sound guided thoracic paravertebral nerve block and combined spinal-epidural anesthesia in percutaneous nephrolithotomy.Methods For 80 patients in our hospital scheduled for percutaneous nephrolithotomy were randomly divided into two groups with 40 cases each.The patients in group GT were given ultra-sound guided thoracic paravertebral nerve block.And the patients in group G were given combined spinal-epidural anesthesia.Observe and compare the aesthesia effects,the hemodynamic changes during body change in perioperative period,adverse reactions after surgery and complications of two groups.Results Anesthetic effects were not significantly different between two groups (P ＞ 0.05).During body change in perioperative period,the MAP and HR of G group were significantly lower than those of GT group.They had significantly difference (P ＜ 0.05).The adverse reactions after surgery and complications of two group were significantly different between two groups(P ＜0.05).The number of patients who have headache and urinary retention are apparently more group G than in group GT.Conclusion Ultra-sound guided thoracic paravertebral nerve block for percutaneous nephrolithotomy has significant anesthetic effect.Hemodynamics is stable during body change in perioperative period.And there is less complications after surgery.
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Objective:To research the effect of lumbar spinal nerve block combined with ultrashort wave on the pain and biomechanics of lumbar back muscle of patients biomechanics with lumbar disc.Methods:98 patients with lumbar disc herniation in our hospital from February 2014 to August 2016,according to the lottery method divided into control group and research group.The control group was treated with Lumbar spinal nerve block.The research group was based on the control group treated with ultrashort wave,clinical curative effect,changes of the visual analogue scale (VAS),60 ° /s angular velocity,120° /s average apical power (AP),peak torque (PT),lumbar dorsiflexion / dorsal flexion (F/E),serum levels of substance P (SP),β-endorphin (β-EP),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α) before and after treatment,and adverse reactions were compared between two groups.Results:The total effective rate of research group was95.91％,which was significant higher than that of the control group,the difference was statistically significant (P＜0.05).After treatment,The VAS,F/E,serum levels of SP,IL-6 and TNF-α of two groups were significantly lower than those before treatment,the above indicators of research group were significantly lower than those of the control group.The AP,PT and serum levels of β-EP between two groups were significantly higher than those before treatment,the above indicators of research group were significantly higher than those of the control group (P＜0.05).No statistical difference was found in the incidence of adverse effects between the two groups (P＞0.05).Conclusion:Umbar spinal nerve block combined with ultrashort wave was more effective than lumbar paravertebral nerve block treatment alone in the treatment of lumbar disc herniation,it could effectively relieve the pain and improve the low back muscle biological mechanics performance and reduce the inflammatory response.
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Objective To explore the effect of paravertebral nerve block for preemptive analgesia on patients with thoracic surgery,and provide reference for clinical anesthesia.Methods From March 2014 to February 2016,102 patients with thoracic surgery in our hospital were selected as the research object,and they were divided into the observation group and the control group with 51 cases in each group according to the anesthesia methods.All the patients were given total intravenous anesthesia.Patients of the control group were injected propofol 1~2 mg/kg,sufentanil 0.4~0.5 g/kg,midazolam 0.1 mg/kg and rocuronium 0.5~0.7 mg/kg,while patients of the observation group were injected ropivacaine(with concentration of 0.5%)5 mL,sufentanil 0.1~0.3 μg·kg-1·min-1 and propofol 6~8 mg·kg-1·min-1 as an addition with the use of ultrasound to guide the paravertebral nerve block.The effect of the two groups were compared.Results The dosage of propofol,remifentanil and rocuronium in the observation group were significantly lower than those in the control group during the operation.The VAS score,postoperative pulmonary complication rate,ICU rate,extubation time,postoperative recovery time at different time of observation group were significantly lower than those of the control group,and SpO2 was higher in control group 30 minutes after tracheal extubation, the differences were significant (P<0.05).Conclusion Paravertebral nerve block requires less dosage of anaesthetic, and it has more significant analgesia effect on patients with thoracic surgery, which can efficiently promote the recovery of patients.
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Objective To observe the effect of ropivacaine on bilateral posterior thoracic paravertebral nerve block for cardiopulmonary bypass.Methods A total of 142 patients undergoing elective cardiac valve surgery,68 males and 74 females,were randomly divided into two groups:group C (general anesthesia,n =69) and group P (general anesthesia+ paraverteral nerve block with ropivacaine,n=73).The changes of hemodynamics,BIS,anesthesia dose and postoperative anesthesia were observed before and after anesthesia,the time of mechanical ventilation,the duration of vasoactive drug support,ICU stay time,length of stay and hospitalization costs were recorded.Results Compared with group C,heart rate and blood pressure were more stable in group P,and the dosage of sufentanil was less [(130.6±5.0) μg vs (202.8±7.4) μg,P＜0.01],the patient was awakened quickly [(241.0±15.8) min vs (417.6±38.9) min,P＜0.05],and the time of mechanical ventilation [(466.0±22.9) min vs (657.8±49.4) min,P＜0.05] and ICU residence time [(22.1±1.0) h vs (34.1±3.6) h,P＜0.05] were shortened,the cost of hospitalization decreased [(72 360±1 565) yuan vs (78 420±2 094) yuan,(P＜0.05)].Conclusion Thoracic paravertebral nerve block anesthesia combined with general anesthesia is better than pure general anesthesia,in terms of maintaining intraoperative circulation stability,reducing the amount of anesthetic analgesic drugs,and early recovery of patients after surgery.
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Objective To investigate the Effects of inflammatory response and postoperative analgesia on thoracic paravertebral nerve block in patients undergoing radical resection of lung cancer. Methods In this study, 68 patients with radical resection of lung cancer were divided into observation group(34 cases)and control group (34 cases)randomly. The anesthesia method of the observation group was general anesthesia combined with thorac-ic paravertebral nerve block ,and the anesthesia method of control group was general anesthesia. Serum IL-6 and IL-10 concentrations were measured before anesthesia(T0),30 min after surgery starts(T1),surgery end(T2),6h after surgery(T3). The visual analogue score of 2 h,12 h,24 h and 48 h postoperatively in two groups were re-corded. The postoperative 24h sufentanil dosage,the number of PCIA pump pressure and the total amount of back-ground infusion were measured. Results Compared with the control group,the serum IL-6 level of T2 and T3 in the observation group were significantly lower than those of the control group ,while the IL-10 concentration was significantly higher in the observation group(P<0.05). The VAS scores of 2 h,12 h and 24 h in the observation group were significantly lower than those in the control group(P<0.05). The 24h sufentanil dosage,PCIA pump pressure and the total amount of background infusion in the observation group were significantly lower than those in the control group(P < 0.05). Conclusions Preoperative thoracic paravertebral nerve block can significantly re-duce the inflammatory response and enhance postoperative analgesia.
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Objective To investigate the Effects of inflammatory response and postoperative analgesia on thoracic paravertebral nerve block in patients undergoing radical resection of lung cancer. Methods In this study, 68 patients with radical resection of lung cancer were divided into observation group(34 cases)and control group (34 cases)randomly. The anesthesia method of the observation group was general anesthesia combined with thorac-ic paravertebral nerve block ,and the anesthesia method of control group was general anesthesia. Serum IL-6 and IL-10 concentrations were measured before anesthesia(T0),30 min after surgery starts(T1),surgery end(T2),6h after surgery(T3). The visual analogue score of 2 h,12 h,24 h and 48 h postoperatively in two groups were re-corded. The postoperative 24h sufentanil dosage,the number of PCIA pump pressure and the total amount of back-ground infusion were measured. Results Compared with the control group,the serum IL-6 level of T2 and T3 in the observation group were significantly lower than those of the control group ,while the IL-10 concentration was significantly higher in the observation group(P<0.05). The VAS scores of 2 h,12 h and 24 h in the observation group were significantly lower than those in the control group(P<0.05). The 24h sufentanil dosage,PCIA pump pressure and the total amount of background infusion in the observation group were significantly lower than those in the control group(P < 0.05). Conclusions Preoperative thoracic paravertebral nerve block can significantly re-duce the inflammatory response and enhance postoperative analgesia.
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Objective To assess the clinical safety and feasibility for ultrasound guided paravertebral block anesthesia of percutaneous nephrolithotomy.Methods Between December 2015 to June 2016,180 patients with renal or ureteral calculi were enrolled and evaluated with uhrasonography and CT scan.Of all the 180 patients,108 males and 82 females.Their mean age was 39 years (23-71 years).The clinical characteristics of the patients in each group,such as age,gender,BMI index,ASA status,mean arterial pressure and disease type had no significant differences (P ＞ 0.05).These patients were randomized into general anesthesia group (G group),combined spinal epidural anesthesia group (C group) and paravertebral nerve block anesthesia group (P group).G group:35 males and 25 females.Their mean age was (40.1 ± 11.8) years and BMI was (25.1 ± 3.8) kg/m2;Renal calculi 52 cases,ureteral calculi 8 cases,Average maximum stone diameter was (2.6 ± 0.8)cm.C group:38 males and 22 females.Their mean age was (39.7 ± 12.4) years and BMI was (24.6 ± 4.1) kg/m2;Renal calculi 54 cases,ureteral calculi 6 cases,Average maximum stone diameter was (2.4 ± 0.8) cm.P group:35 males and 25 females.Their mean age was (38.9 ± 12.7) years and BMI was (25.4 ± 4.0) kg/m2;Renal calculi 51 cases,ureteral calculi 9 cases,Average maximum stone diameter was (2.5 ± 0.7) cm.Periprocedural Vital signs,complications,the times of anal discharging gas and postoperative feeding,hospitalized day and expense in these three groups were evaluated.Results Major intraoperative or postoperative complications did not occur in all of the patients.Mean arterial pressure decreased during preoperative changing positions was observed in group G (mean decreased 8.8 mmHg)and group C (mean decreased 1.9 mmHg),with significant difference in intra-group (P ＜ 0.05).Postoperative nausea and vomiting was observed in 8 and 2 patients of group G and group P,respectively (P ＜ 0.05).Postoperative pain was observed in 2 and 7 patients of group C and group P,respectively (P ＞ 0.05).In addition,group P had early post operation feeding time [(6.4 ± 2.4) h],shorter hospitalized day [(4.5 ± 1.1) d] and lower hospitalized expense compared with other groups (P ＜ 0.05).Conclusions Ultrasound guided paravertebral block can provide safe and reliable surgical anesthesia for percutaneous nephrolithotomy.