Masa paravertebral torácica como manifestación infrecuente del Linfoma de alto grado: Reporte de un caso

Paciente masculino de 44 años sin antecedentes patológicos previos, acude por cuadro de disnea y dolor pleurítico en hemitórax derecho. La radiografía de tórax tomada a su ingreso muestra importante derrame pleural derecho. Fue evaluado por el servicio de Neumología quienes realizan toracocentesis diagnóstica y evacuadora. Además, solicitaron tomografía contrastada de tórax, la cual reporta una gran masa mediastínica posterior (paravertebral), asociada a aparente infiltración de la médula ósea en múltiples cuerpos vertebrales, y adenopatías inguinales bilaterales. Posteriormente se realiza biopsia de la masa paravertebral, confirmando uno de los diagnósticos infrecuentes presentados como masas del mediastino posterior, Linfoma de células B grande. (provisto por Infomedic International)

A 44-year-old male patient with no previous medical history presented with dyspnea and pleuritic chest pain in the right hemithorax. The chest x-ray taken upon admission shows significant right pleural effusion. He was evaluated by the Pulmonology department who performed diagnostic and evacuative thoracentesis. In addition, they requested contrast-enhanced chest tomography, which reported a large posterior mediastinal (paravertebral) mass, associated with apparent bone marrow infiltration of multiple vertebral bodies, and bilateral inguinal lymphadenopathy. Subsequently, a biopsy of the paravertebral mass was performed, confirming one of the rare diagnoses presented as posterior mediastinal masses, large B-cell Lymphoma. (provided by Infomedic International)

Study on Analgesic Effects of Combined Thoracic Paravertebral Block Anesthesia or Erector Spinae Plane Block with Ultrasound Guided Transversus Abdominis Plane Block in Endoscopic Esophagectomy: A Clinical Anatomical Approach

SUMMARY: The application effect of transversus abdominis plane block (TAPB) combined with thoracic paravertebral block (TPVB) or erector spinae plane block (ESP) under ultrasound guidance in endoscopic radical resection of esophageal cancer under general anesthesia was studied. From March 2021 to February 2022, patients who underwent endoscopic radical resection of esophageal cancer in our hospital were selected as the research object, and 90 patients were selected as the samples. Patients were divided into groupA and group B according to the difference of blocking schemes. Group A received ESP and Group B received TPVB. The dosage of sufentanil, nerve block time, awakening time and extubation time of the two groups were counted. The postoperative pain, sedation effect, sleep satisfaction and analgesia satisfaction of the two groups were compared, and the complications of the two groups were observed. The nerve block time and extubation time in group A were shorter than those in group B (P0.05). At T2, T3 and T4, the visual analogue scale (VAS) scores of group A at rest and cough were significantly lower than those of group B (P0.05). The satisfaction of sleep and analgesia in group A was higher than that in group B (P0.05). The analgesic effect of ultrasound-guided TAPB combined with ESP is better than that of ultrasound-guided TAPB combined with TPVB, and it can shorten the time of nerve block and extubation, which is worth popularizing.

Se estudió el efecto de la aplicación del bloqueo del plano transverso del abdomen (TAPB) combinado con el bloqueo paravertebral torácico (TPVB) o el bloqueo del plano del erector de la columna (ESP) bajo guía ecográfica en la resección radical endoscópica del cáncer de esófago bajo anestesia general. Desde marzo de 2021 hasta febrero de 2022, en nuestro hospital, se seleccionaron como objeto de investigación pacientes sometidos a resección radical endoscópica de cáncer de esófago, y como muestra se seleccionaron 90 pacientes. Los pacientes se dividieron en el grupo A y el grupo B según la diferencia de esquemas de bloqueo. El grupo A recibió ESP y el grupo B recibió TPVB. Se contaron la dosis de sufentanilo, el tiempo de bloqueo nervioso, el tiempo de despertar y el tiempo de extubación de los dos grupos. Se compararon el dolor posoperatorio, el efecto de la sedación, la satisfacción del sueño y la satisfacción de la analgesia de los dos grupos y se observaron las complicaciones de los dos grupos. El tiempo de bloqueo nervioso y el tiempo de extubación en el grupo A fueron más cortos que los del grupo B (P0,05). En T2, T3 y T4, las puntuaciones de la escala visual analógica (EVA) del grupo A en repo- so y tos fueron significativamente más bajas que las del grupo B (P 0,05). La satisfacción del sueño y la analgesia en el grupo A fue mayor que en el grupo B (P0,05). El efecto analgésico de la TAPB guiada por ecografía combinada con ESP es mejor que el de la TAPB guiada por ecografía combinada con TPVB, y puede acortar el tiempo de bloqueo nervioso y extubación, lo que vale la pena popularizar.

A novel comparison of erector spinae plane block and paravertebral block in laparoscopic cholecystectomy

SUMMARY OBJECTIVE: Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases. METHODS: The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively. RESULTS: The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups. CONCLUSION: Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.

Ultrasound-Guided Continuous Thoracic Paravertebral Block Improves Patient's Quality of Recovery After Open Hepatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial / 中国医学科学杂志(英文版)

Background Ultrasound-guided continuous thoracic paravertebral block can provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy. We hypothesize that these effects may improve the quality of recovery (QoR) after open hepatectomy. Methods Seventy-six patients undergoing open hepatectomy were randomized to receive a continuous thoracic paravertebral block with ropivacaine (CTPVB group) or normal saline (control group). All patients received patient-controlled intravenous analgesia with morphine postoperatively for 48 hours. The primary outcome was the global Chinese 15-item Quality of Recovery score on postoperative day 7, which was statistically analyzed using Student's t-test. Results Thirty-six patients in the CTPVB group and 37 in the control group completed the study. Compared to the control group, the CTPVB group had significantly increased global Chinese 15-item Quality of Recovery scores (133.14 ± 12.97 vs. 122.62 ± 14.89, P = 0.002) on postoperative day 7. Postoperative pain scores and cumulative morphine consumption were significantly lower for up to 8 and 48 hours (P < 0.05; P = 0.002), respectively, in the CTPVB group. Conclusion Perioperative CTPVB markably promotes patient's QoR after open hepatectomy with a profound analgesic effect in the early postoperative period.

Value of pressure-strain loop in evaluating the effects of thoracic paravertebral block on left ventricular function before off-pump coronary artery bypass graft / 中华超声影像学杂志

Objective:To observe the effects of bilateral thoracic paravertebral block (TPVB) on left ventricular myocardial work using pressure-strain loop(PSL) in patients before off-pump coronary artery bypass graft(OPCABG).Methods:A total of 24 patients with coronary heart disease undergoing selective OPCABG were recruited in the First Affiliated Hospital of Nanjing Medical University from May to August 2021. All patients underwent ultrasound-guided TPVB preoperatively. Left ventricular global work, including global longitudinal strain(GLS), global work index(GWI), global constructive work(GCW), global waste work(GWW), global work efficiency(GWE), and regional work, including myocardial work index(MWI), myocardial work efficiency(MWE) were observed before TPVB and 20 minutes after TPVB.Results:The parameters of heart rate and left ventricular outflow tract blood flow were decreased [(69.13±10.72)bpm vs (65.46±9.66)bpm, P=0.010; (13.86±2.83)ml vs (12.72±2.60)ml, P=0.017]. The MWI in regional segments of hypokinesis and akinesis were significantly improved [hypokinesis: (1 175.76±206.64)mmHg% vs (1 349.38±462.35)mmHg%, P=0.004; akinesis: (684.94±251.39)mmHg% vs (965.35±384.33)mmHg%, P=0.001] and the MWE in regional segments of hypokinesis and akinesis were improved [hypokinesis: (87.79±7.46)% vs (90.35±6.39)%, P=0.029; akinesis: (70.24±18.03)% vs (80.15±16.65)%, P=0.021]. There were no significant changes in MWI, MWE, LVEF, GLS, GWI, GCW, GWW and GWE(all P>0.05). Conclusions:Based on PSL, the changes of left ventricular work in patients with OPCABG before and after TPVB show that TPVB can improve the blood supply of the ischemic myocardium, which provides a reliable basis for optimizing the perioperative anesthesia management.

Application of the flipped classroom combined with 3D Body anatomy software in ultrasound-guided thoracic paravertebral block training / 中华医学教育探索杂志

Ultrasound-guided thoracic nerve block plays an important role in anesthesia and analgesia, but it is not easy to be mastered. This article discusses the application value of flipped classroom combined with 3D Body anatomy software for anesthesia specialty residents to learn ultrasound-guided thoracic paravertebral nerve block. This innovative education model includes three parts: before class, during class and after class. Before class, the teachers study the syllabus and make teaching micro-videos, and the cross-sectional anatomy added into the 3D Body anatomy software helps the residents understand. During class, teachers divide the residents into groups to report and exchange their learning experience, organize discussions, and finally give them comments. After class, the instructor will assign homework, assess the residents, and evaluate their satisfaction. This teaching model helps residents master the ultrasound-guided thoracic nerve block, and obtains satisfactory evaluation from the trainees, which is helpful for promotion.

Degenerative characteristics and biomechanical effects of paravertebral muscles in patients with degenerative lumbar scoliosis / 中国医师进修杂志

Objective:To investigate the degenerative characteristics and biomechanical effects of paravertebral muscles in patients with degenerative lumbar scoliosis.Methods:The clinical data of 236 patients with degenerative lumbar scoliosis from January 2016 to January 2020 in Yuncheng Central Hospital of Shanxi Province were retrospectively analyzed. All patients underwent lumbar X-ray and MRI measurement, and the indexes included coronal scoliosis Cobb angle, rotation classification of apical vertebra, cross-sectional area (CSA) of the apical vertebra upper and lower intercalated disc plane, fatty infiltration rate (FIR) of psoas major and back extensor muscle group (including erector spinae and multifidus muscle), cross-sectional area difference index (CDI) and fatty infiltration difference (FID). The correlation between paravertebral muscle degeneration and coronal scoliosis Cobb angle was evaluated.Results:The coronal scoliosis Cobb angle of 236 patients was 10.4° to 57.8° (18.72 ± 6.44)°; there were no statistical differences in coronal scoliosis Cobb angle and rotation classification of apical vertebra between different sex, scoliosis direction and apical vertebra position ( P>0.05). In the apical vertebra upper intercalated disc plane, the concave side CSA of psoas major muscle was significantly higher than convex side: (3.82 ± 1.06) cm 2 vs. (3.68 ± 1.01) cm 2, the concave side CSA of multifidus muscle, back extensor muscle group and paraspinal muscle group (including psoas major muscle, quadratus lumborum, erector spinae and multifidus muscle) was significantly lower than convex side: (9.80 ± 2.14) cm 2 vs. (10.46 ± 2.60) cm 2, (18.18 ± 3.03) cm 2 vs. (19.79 ± 3.22) cm 2 and (25.25 ± 5.06) cm 2 vs. (27.86 ± 6.90) cm 2, and there were statistical differences ( P<0.05 or <0.01); there were no statistical differences in CSA of quadratus lumborum and erector spinae between concave side and convex side ( P>0.05). In the apical vertebra lower intercalated disc plane, the concave side CSA of psoas major muscle and quadratus lumborum was significantly higher than convex side: (6.62 ± 3.09) cm 2 vs. (6.40 ± 3.23) cm 2 and (4.58 ± 0.57) cm 2 vs. (4.45 ± 0.64) cm 2, the concave side CSA of multifidus muscle and back extensor muscle group was significantly lower than concave side: (9.49 ± 3.10) cm 2 vs. (10.32 ± 4.06) cm 2 and (19.31 ± 4.36) cm 2 vs. (20.54 ± 5.60) cm 2, and there were statistical differences ( P<0.01 or <0.05); there was no statistical difference in CSA of erector spinae and paraspinal muscle group between concave side and convex side ( P>0.05). In apical vertebra upper and lower intercalated disc plane, the concave side FIR of back extensor muscle group was significantly higher than convex side: (31.83 ± 11.04)% vs. (24.37 ± 12.76)% and (38.62 ± 10.09)% vs. (31.80 ± 8.23)%, and there was statistical difference ( P<0.01); there was no statistical difference in FIR of psoas major muscle between concave side and convex side ( P>0.05). Pearson linear correlation analysis result showed that CDI of multifidus muscle, back extensor muscle group, paraspinal muscle group and FID of back extensor muscle group were positively correlated with coronal scoliosis Cobb angle (apical vertebra upper intercalated disc plane: r = 0.94, 0.70, 0.86 and 0.90, P<0.01; apical vertebra lower intercalated disc plane: r = 0.92, 0.94, 0.81 and 0.66, P<0.01); the CDI of psoas major muscle in apical vertebra lower intercalated disc plane was positively correlated with coronal scoliosis Cobb angle ( r = 0.73, P<0.01); there was no correlation between CDI of psoas major muscle in apical vertebra upper intercalated disc plane and coronal scoliosis Cobb angle ( r = 0.17, P>0.05). In patients with apical vertebra located in L 2 and L 3, the CSA of psoas major muscle and quadratus lumborum in apical vertebra lower intercalated disc plane was significantly higher than that in apical vertebra upper intercalated disc plane, and there was statistical difference ( P<0.01); in patients with apical vertebra located in L 2, the concave side CSA of erector spinae in apical vertebra lower intercalated disc plane was significantly higher than that in apical vertebra upper intercalated disc plane, and there was statistical difference ( P<0.01). Conclusions:The biomechanical effects of lumbar flexion/ back extensor muscle group should be different in the process of disease progression in patients with degenerative lumbar scoliosis, in which the back extensor muscle group can effectively inhibit the degenerative disease. The protection of paravertebral muscle group function should be placed in an important role in degenerative lumbar scoliosis treatment.

Single Shot Paravertebral Block - A Novel Approach for Post-Operative Analgesia in Breast Surgeries

Advancements in diagnostic sciences have led to increased frequency in detection of cases of breast cancer. After confirmation, majority of these patients undergo definitive surgeries commonly Modified Radical Mastectomy or Lumpectomy under general anaesthesia. In addition to inadequate pain control there is increased incidence of nausea and vomiting during first 24 hrs. of the post-operative period with GA. Parenteral narcotic used routinely in postoperative period further increases nausea and vomiting. The large number of patients hospitalized annually for breast cancer surgeries results in heavy costs and long hospital stays. Regional anaesthesia using prep-incisional paravertebral block (PVB) maybe an ideal alternative to GA alone for breast cancer surgery. Benefits include prolonged postoperative pain relief, reduction in postoperative nausea and vomiting and has potential for early discharge. It results in unilateral sensory, motor and sympathetic blockade with additional advantages of lower side effect profile, early mobilization and fewer contraindications. We wanted to study the efficacy of paravertebral block for postoperative pain relief in breast surgeries. METHODSA prospective, randomized, comparative study involving 60 adult female patients posted for Ca breast surgery was conducted. One group received pre-incisional PVB with GA (group A) and another received GA alone (group B). The efficacy of analgesia and PONV were assessed using Visual Analogue Scale and Numeric Rating Score respectively at T1, 2, 3, 4, 5, 6, 12, 24, 48 hours. Fentanyl 2 mic / Kg as rescue analgesic and ondansetron 0.1 mg / Kg as antiemetic were given at VAS >/= 4 and NRS >/= 2. Total opioid and antiemetic consumption was noted. RESULTSTotal VAS and NRS scores of Group A was significantly lower than Group B. Also significantly reduced consumption of analgesic and antiemetic was observed in Group A. ∑VASA = (3.37 + 2.76) while ∑ VASB = (19.23 + 3.32) while, Group A ∑NRS = (0.47 + 0.67) and Group B ∑NRS = (5.27 + 1.34). CONCLUSIONSPVB provides significant pain relief with decreased incidence of PONV and has the additional advantage of lesser consumption of opioids and antiemetics in the immediate postoperative period.

The effect of thoracic paravertebral block on seroma reduction in breast surgery - a randomized controlled trial / Efeito do bloqueio paravertebral torácico na redução de seroma em cirurgia de mama - estudo randomizado controlado

Abstract Background: Increasing number of patients are being operated because of breast cancer. Seroma is the most common problem that occurs after surgery that increases morbidity. For postoperative pain management, Thoracic Paravertebral Block (TPVB) has long been considered the gold standard technique. With performing TPVB, sympathetic nerves are also blocked. Objective: With this study, we aimed to search the effect of TPVB on seroma reduction in patients who undergo mastectomy and axillary node dissection surgery. Methods: Forty ASA I-II female patients aged 18-65, who were scheduled to go under elective unilateral mastectomy and axillary lymph node resection were included to the study. Patients were randomized into two groups as TPVB and Control group. Ultrasound guided TPVB with 20 mL 0.25% bupivacaine was performed at T1 level preoperatively to the TPVB group patients. All patients were provided with i.v. patient-controlled analgesia device. Seroma formation amounts, morphine consumptions and Numeric Rating Scale (NRS) scores for pain were recorded 24th hour postoperatively. Results and conclusions: Mean seroma formation at postoperative 24th hour was 112.5 ± 53.3 mL in the control group and 74.5 ± 47.4 mL in the TPVB group (p = 0.022). NRS scores were similar between two groups (p = 0.367) at postoperative 24th hour but mean morphine consumption at postoperative 24th hour was 5.6 ± 4 mg in the TPBV group, and 16.6 ± 6.9 mg in the control group (p < 0.001). TPVB reduces the amount of seroma formation while providing effective analgesia in patients who undergo mastectomy and axillary lymph node removal surgery.

Resumo Introdução: Observa-se aumento do número de pacientes submetidos à cirurgia por neoplasia mamária. Seroma é a mais frequente complicação pós-operatória que aumenta a morbidade. Há muito tempo, considera-se o Bloqueio Paravertebral Torácico (BPVT) a técnica padrão-ouro para o controle da dor pós-operatória. O BPVT provoca, igualmente, o bloqueio da inervação simpática. Objetivo: Identificar o efeito do BPVT na redução de seroma em pacientes que realizaram mastectomia e dissecção dos linfonodos axilares. Método: Foram incluídas no estudo 40 pacientes do sexo feminino ASA I-II, entre 18 e 65 anos de idade, submetidas a mastectomia eletiva unilateral com ressecção de linfonodos axilares. As pacientes foram randomizadas em grupo BPVT e grupo controle. As pacientes do grupo BPVT foram submetidas ao BPVT guiado por ultrassom no nível de T1 e 20 mL de bupivacaína 0,25% foram administrados antes da cirurgia. Bomba de infusão IV ACP foi prescrita para todas as pacientes. Na 24ª hora pós-operatória foram registradas a quantidade de produção de seroma, o consumo de morfina e a avaliação da dor pela escala de avaliação numérica (NRS - do inglês Numeric Rating Scale). Resultados: A quantidade média de seroma na 24ª hora pós-operatória foi 112,5 ± 53,3 mL no grupo controle e 74,5 ± 47,4 mL no grupo BPVT (p = 0,022). Na 24ª hora pós-operatória a pontuação NRS foi semelhante nos dois grupos (p = 0,367), porém o consumo médio de morfina foi 5,6 ± 4 mg no grupo BPVT e 16,6 ± 6,9 mg no grupo controle (p < 0,001). Conclusões: O BPVT reduz a quantidade de seroma enquanto proporciona analgesia efetiva em pacientes que se submetem a mastectomia e remoção dos linfonodos axilares.

Efficacy of paravertebral block techniques in thoracic surgery: systematic literature review / Eficacia de las técnicas de bloqueo paravertebral en cirugía torácica. Revisión sistemática de la literatura

Abstract Introduction: Postoperative pain in thoracic surgery in adults is usually severe, and to control it there are many analgesic methods that include paravertebral blockade (PVB). Until now, there is no clarity on which is the most effective technique to perform this blockade. Objective: To describe the different PVB techniques and its analgesic effect in thoracic surgery. Methods: A systematic review of the literature was performed. We included studies that analyzed patients in open chest surgery and used PVB as analgesic technique. The Cochrane and Grading of Recommendation Assessment, Development and Evaluation strategies were used to analyze biases and evidence. The results are presented graphically by means of a visual analog scale (VAS) pain and opioid consumption equivalent to morphine for each technique found. We summarize the results with a qualitative approach without meta-analysis. Results: A total of 38 articles were analyzed (2188 patients). 13 using PVB guided by surface anatomy (SA-PVB), 7 Ultrasound-guided PVB (US-PVB), 1 neurostimulation guided PVB (NE-PVB) and the remaining using PVB performed under direct visualization by the surgeon (S-PVB). A VAS of less than 3 was found in studies with SA-PVB and US-PVB, and greater than 5 in studies with S-PVB; however, opioid consumption in the postoperative period was similar between the techniques described. Conclusion: PVB can be performed through 4 techniques. Techniques of US-PVB or SA-PVB have shown better consistency to manage postoperative acute pain in thoracic surgery.

Resumen Introducción: El dolor posoperatorio en cirugía de tórax en adultos usualmente es grave, y para su control existen varios métodos analgésicos que incluyen el bloqueo paravertebral (BPV). En la actualidad no hay claridad acerca de la técnica más efectiva para su realización. Objetivo: Describir las diferentes técnicas de colocación del BPV y su efecto en el control analgésico en cirugía de tórax. Métodos: Se realizó una revisión sistemática de la literatura. Se incluyeron estudios que analizaron pacientes sometidos a cirugía de tórax abierta y que utilizaron el BPV como técnica analgésica. Se emplearon las estrategias Cochrane y GRADE (Grading of Recommendation Assessment, Development and Evaluation) para valorar la evidencia disponible. Se presentan los resultados de manera gráfica mediante escala visual análoga de dolor y consumo de opioide equivalente a morfina para cada técnica encontrada. Se realizó síntesis cualitativa de los resultados sin metanálisis. Resultados: Se analizaron en total 38 artículos (2188 pacientes). 13 estudios usaban BPV guiado por anatomía de superficie (BPV-AS), 7 BPV con guía ecográfica (BPV-US), 1 BPV guiado por neuroestimulación (BPV-NE) y los restantes BPV bajo visualización directa por el cirujano (BPV-C). Se encontró una escala visual análoga (EVA) menor a 3 en los estudios con BPV-AS y BPV-US y mayor a 5 en estudios con BPV-C; sin embargo, el consumo de opioides en el posoperatorio fue similar entre las técnicas descritas. Conclusión: Se han descrito cuatro técnicas para la realización del BPV. Las técnicas de BPV-US o BPV-AS han mostrado mejor consistencia para el manejo del dolor agudo posoperatorio en cirugía de tórax.

Feasibility of non-intubated anesthesia and regional block for thoracoscopic surgery under spontaneous respiration: a prospective cohort study

Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1-T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.

Effects of different postoperative analgesic strategies on postoperative neurocognitive function and quality of recovery in elderly patients undergoing one lung ventilation / 南方医科大学学报

OBJECTIVE@#To evaluate the effects of different postoperative analgesic strategies on neurocognitive function and quality of recovery in elderly patients at 7 days after thoracic surgery with one lung ventilation.@*METHODS@#Ninety elderly patients undergoing video-assisted thoracic surgery were randomized into 3 groups (@*RESULTS@#The patients in TA and EA groups had significantly higher MMSE scores and lower incidence of postoperative neurocognitive dysfunction (PNCD) than those in GA group without significant difference between the former two groups. At 7 days after the surgery, serum levels of S100-β and MMP-9 were significantly higher in GA group than in TA and EA group, and did not differ significantly between the latter two groups. QoR-40 scores were significantly higher in TA and EA groups than in GA group, and were higher in TA group than in EA group. The chest intubation time and length of hospital stay were significantly shorter in TA and EA groups than in GA group.@*CONCLUSIONS@#In elderly patients undergoing surgeries with one lung ventilation, general anesthesia combined with either postoperative continuous thoracic paravertebral block or epidural analgesia can significantly improve postoperative neurocognitive function and quality of recovery, but continuous thoracic paravertebral block analgesia can be more advantageous for improving postoperative quality of recovery.

Ultrasound-guided paravertebral nerve block for zoster-associated pain: A meta-analysis / 中国组织工程研究

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.

Establishment and application of paravertebral muscle endurance and left-right symmetry measurement indexes and methods in teenagers / 中国组织工程研究

BACKGROUND: Surface electromyography has Indicated that non-specific chronic low back pain patients have Inconsistent changes in the motion of erector spinae muscles on both sides of the lumbar spine. Existing physical fitness evaluation focuses on the evaluation of the overall strength of the waist, whereas there is no report on the evaluation methods and indicators of paravertebral muscle in teenagers. OBJECTIVE: To establish methods and indicators for assessing teenagers' paravertebral muscle endurance and left-right symmetry, and to preliminarily formulate evaluation criteria. METHODS: Two hundred students, aged 13-18 years, were randomly selected In a middle school of Beijing, half male and half female. There were 100 junior high school students and 100 high school students. All the subjects did Biering-Sorensen (B-S) exercise to maintain Isometric contraction of paravertebral muscles, and surface electromyography was then used to record the electromyography of bilateral erector spine muscles (ES) of L3-L4 and multifidus muscles (MF) of L5-S 0. 05, and correlation coefficient within the group was ICC > 0. 80 (P < 0. 01), indicating a good repeatability. Fitting composite Index, the Index v=slopeMPF (LES+RES+LMF+RMF)/4 was used to evaluate teenagers' paravertebral muscular endurance, and u=slopeMPF (LES-RES)/slopeMPF (LES+RES)+slopeMPF (LMF-RMF)/slopeMPF (LMF+RMF) was to evaluate the left-right symmetry. The evaluation results revealed that the paravertebral muscle endurance of high school students of the same sex was Increased In relative to junior high school students (P < 0. 01). There were significant differences in paravertebral muscle endurance between male and female students In high school. The teenagers' paravertebral muscle endurance and symmetry showed normal distribution, and could be graded by deviation method. In this study, the Indexes and methods for evaluating paravertebral muscle endurance and left-right symmetry were preliminarily established, and the criteria for evaluating juvenile paravertebral muscle endurance and left-right symmetry were preliminarily established by deviation method.

Analgesia en cirugía torácica (toracotomía) / Analgesia in thoracic surgery (thoracotomy)

Resumen: La cirugía torácica abierta se encuentra entre las cirugías más dolorosas y sus resultados se ven afectados adversamente por el malestar postoperatorio. La analgesia óptima en toracotomía, la disminución en el consumo de narcóticos, un despertar rápido y predecible, la prevención de efectos adversos, la movilización temprana y maniobras de fisioterapia respiratoria, así como el uso seguro de fármacos en recuperación y piso, son las estrategias más importantes para un manejo óptimo perioperatorio. Hasta hace unos años, la analgesia epidural era considerada el estándar analgésico; sin embargo, intervenciones como el bloqueo paravertebral también han sido evaluadas. El síndrome de dolor postoracotomía (PTPS) es una complicación bien reconocida, su incidencia varía entre el 15 y 67% de acuerdo con la definición. Se realizó la búsqueda en diversas fuentes de literatura para poder emitir recomendaciones perioperatorias, con mayor evidencia, esto se realizó con un equipo multidisciplinario para la emisión del manejo multimodal del dolor (visita http://www.painoutmexico.com para obtener la versión completa del artículo y el diagrama de recomendaciones).

Abstract: Open thoracic surgery is among the most painful surgeries and its results are adversely affected by postoperative discomfort. The optimal analgesia in thoracotomy, the decrease in the consumption of narcotics, a rapid and predictable awakening, the prevention of adverse effects, the early mobilization and maneuvers of respiratory physiotherapy, as well as the safe use of drugs, are the most important strategies for optimal perioperative management. Until a few years ago, epidural analgesia was considered the gold standard, however, interventions such as paravertebral block have been evaluated as well. Post-thoracotomy pain syndrome (PTPS) is a well-recognized complication, its incidence varies between 15 and 67% according to the definition. This review includes recommendations of literature sources to be able to translate perioperative recommendations with the highest evidence level, this was done including a multidisciplinary team for the issuance of multimodal pain management (visit http://www.painoutmexico.com to see the full article and recommendations diagram).

Disseminated Nocardia farcinica infection presenting as a paravertebral abscess in a patient with systemic lupus erythematosus

Disseminated Nocardia infections occur particularly in immunosuppressed hosts and are most often due to Nocardia farcinica, Nocardia nova, and Nocardia cyriacigeorgica. Here, we report an unusual case of disseminated N. farcinica infection presenting as a paravertebral abscess in a patient with systemic lupus erythematosus.

Addition of dexmedetomidine to bupivacaine in ultrasonography-guided paravertebral blockade potentiates postoperative pain relief among patients undergoing thoracotomy / Adição de dexmedetomidina à bupivacaína em bloqueio paravertebral guiado por ultrassom potencializa o alívio da dor pós-operatória em pacientes submetidos à toracotomia

Abstract Background and objective: Thoracic paravertebral blockade is an alternative regional technique for comforting post-thoracotomy pain, thereby decreasing opioid consumption, postoperative nausea and vomiting, dizziness, respiratory depression and health care costs. The objective of this study was to investigate the effects of bupivacaine and bupivacaine plus dexmedetomidine on postoperative pain score and analgesic consumption in thoracotomy patients who had undergone ultrasonography-guided paravertebral blockade. Material and method: 93 ASA I-II patients aged 18-65 years were included in the study and scheduled for thoracic surgery. Prior to anesthesia induction, the paravertebral blockade procedure was performed by an anesthetist with ultrasonography. Cases were randomly stratified into three groups. The paravertebral blockade procedure was performed with 20 mL 0.5% bupivacaine injection in Group B (n = 31) and 20 mL 0.5% bupivacaine + 1 mL dexmedetomidine (100 µg) injection in Group BD. Group C received postoperative i.v. morphine via patient-controlled analgesia without paravertebral blockade. Post-operative pain scores were recorded in the recovery room and post-operatively using a VAS. Hemodynamic parameters, adverse effects and morphine consumption were also recorded. Results: No significant difference was determined between Group B and Group C regarding intra-operative adverse effects such as bradicardia and hypotension, while these adverse effects were significantly higher in Group BD (p = 0.04). VAS scores with rest and upon movement were significantly lower in Group BD compared to Group C (p < 0.001). Total morphine consumption was significantly lower in both Group B and Group BD in comparison with Group C (p < 0.001). In Group BD, HR and MAP were lower, but this was not clinically significant (p < 0.05). Conclusion: The addition of dexmedetomidine to bupivacaine lowers postoperative pain scores and morphine consumption in thoracotomy patients who receive ultrasonography guided paravertebral blockade.

Resumo Justificativa e objetivo: O bloqueio paravertebral torácico é uma técnica regional opcional para o alívio da dor pós-toracotomia, deste modo diminui o consumo de opioides, náuseas e vômitos no pós-operatório, tontura, depressão respiratória e custos com saúde. O objetivo deste estudo foi investigar os efeitos de bupivacaína isolada e bupivacaína + dexmedetomidina no escore de dor pós-operatória e no consumo de analgésicos em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom. Material e método: Noventa e três pacientes, ASA I-II, com idades entre 18 e 65 anos, foram incluídos no estudo e programados para cirurgia torácica. Antes da indução anestésica, o procedimento de bloqueio paravertebral foi realizado por um anestesista com o uso de ultrassom. Os casos foram estratificados aleatoriamente em três grupos. O procedimento de bloqueio paravertebral foi realizado com injeção de 20 mL de bupivacaína a 0,5% no Grupo B (n = 31) e de 20 mL de bupivacaína a 0,5% + 1 mL de dexmedetomidina (100 µg) no Grupo BD. O Grupo C recebeu morfina intravenosa via analgesia controlada pelo paciente sem bloqueio paravertebral. Os escores de dor pós-operatória foram registrados na sala de recuperação e no pós-operatório usando a escala VAS. Parâmetros hemodinâmicos, efeitos adversos e consumo de morfina também foram registrados. Resultados: Não houve diferença significativa entre os grupos B e C em relação a efeitos adversos intraoperatórios, como bradicardia e hipotensão, enquanto esses efeitos adversos foram significativamente maiores no Grupo BD (p = 0,04). Os escores VAS em repouso e movimento foram significativamente menores no Grupo BD em relação ao Grupo C (p < 0,001). O consumo total de morfina foi significativamente menor nos grupos B e BD em comparação com o Grupo C (p < 0,001). No Grupo BD, a frequência cardíaca e a pressão arterial média foram menores, mas esse resultado não foi clinicamente significativo (p < 0,05). Conclusão: A adição de dexmedetomidina à bupivacaína reduz os escores de dor pós-operatória e o consumo de morfina em pacientes submetidos à toracotomia sob bloqueio paravertebral guiado por ultrassom.

Comparison of postoperative analgesic effect between serratus plane block and thoracic paravertebral block in patients undergoing thoracoscopic surgery / 临床麻醉学杂志

Objective To compare the postoperative analgesic effect between serratus plane block and thoracic paravertebral block in patients undergoing thoracoscopic surgery.Methods Sixty patients undergoing thoracoscopic surgery, 38 males and 22 females, aged 18-65, BMI 18-25 kg/m2, falling into ASA physical status I or II.They were divided into groups S and T by random number table, 30 cases in each group.Two groups of patients were treated with general anesthesia with endobronchial intubation and PCIA after operation.Group S performed Ultrasound-guided serratus plane block and group T performed thoracic paravertebral block, 0.4％ropivacaine 30 ml were used in the two groups.The two groups of patients were observed 30 min after block, and the sensory block plane was measured with acupuncture and recorded.Recording operation time, onset time and duration of the block.Resting and cough VAS score were recorded at 2, 4, 8, 12, 24, and 48 hafter surgery.The first pressing time of the analgesic pump and times of press analgesic pump, the amount of sufentanil used and times the number of cases of useing piperidine were recorded within 48 hafter operation.Block related complications and analgesic related adverse reactions were recorded.Results Compared with group T, the operation time of the block obviously shortening but the duration obviously lengthening (P<0.01).Resting and cough VAS score at 12 hafter surgery significantly was lower (P<0.01).The first pressing time of the analgesic pump obviously lengthening, the number of press analgesic pump and the amount of sufentanil used significantly were reduced (P<0.01) in group S.Conclusion Ultrasound guided SP block and TPVB block can provide good postoperative analgesia for patients undergoing thoracoscopic surgery, but SP block is more durable, with less operation time and complications than TPVB block, and can effectively reduce the opioid demand and incidence of nausea and vomiting after operation.

Design of Paravertebral Muscle Monitoring System Based on Surface Electromyography / 中国医疗器械杂志

In order to diagnose and evaluate the human spinal lesions through the paravertebral muscles, a paravertebral muscle monitoring system based on surface EMG signals was designed. The system used surface mount electrodes to obtain the surface myoelectric signal (sEMG) of paravertebral muscle. The signal was filtered and amplified by the conditioning circuit. The signal was collected by the microcontroller NRF52832 and was sent to the mobile APP. After the signal was preprocessed by the wavelet threshold denoising algorithm in APP, the time and frequency characteristics of the sEMG signal reflecting the functional state of the muscle were extracted. The calculated characteristic parameters was displayed in real time in the application interface. The experimental results show that the system meets the design requirements in analog signal acquisition, digital processing of signals and calculation of characteristic parameters. The system has certain application value.

Study on the analgesic effect of ultrasound-guided paravertebral nerve block on patients with radical mastectomy / 肿瘤研究与临床

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.