• Analgesia
• Anesthesia
• Lumbar spinal surgery
• Retrolaminar block

• Humans
• Male
• Female
• Middle Aged
• Nerve Block/methods
• Decompression, Surgical/methods
• Lumbar Vertebrae/surgery
• Pain, Postoperative/prevention & control
• Pain, Postoperative/drug therapy
• Prospective Studies
• Aged
• Adult
• Ultrasonography, Interventional/methods
• Anesthetics, Local/administration & dosage

• Education
• Eponyms
• History of anatomy
• Language
• Terminology

• Anatomy/education
• United Kingdom
• Terminology as Topic
• Humans
• History, 19th Century
• History, 20th Century
• History, 21st Century
• Schools, Medical
• Education, Medical/trends

• Chronic postoperative pain
• Patient-controlled intravenous analgesia
• Thoracic epidural anesthesia
• Thoracic surgery
• Video-assisted thoracoscopic surgery

• analgesia
• fascial plane block
• postoperative pain
• regional anaesthesia
• thoracic
• truncal fascial plane block

• Humans
• Nerve Block/adverse effects
• Nerve Block/methods
• Pain Management/methods
• Pain, Postoperative/prevention & control
• Pain, Postoperative/etiology
• Anesthesia, Conduction/methods
• Analgesics

• Chronic pain after breast cancer surgery
• Cytokines
• Erector spinae plane block
• Modified radical mastectomy
• Nerve block
• Perioperative analgesia
• Post-mastectomy pain syndrome

• Humans
• Female
• Breast Neoplasms/surgery
• Chronic Pain/diagnosis
• Chronic Pain/etiology
• Chronic Pain/prevention & control
• Acute Pain
• Mastectomy, Modified Radical/adverse effects
• Mastectomy/adverse effects
• Pain, Postoperative/diagnosis
• Pain, Postoperative/etiology
• Pain, Postoperative/prevention & control
• Anesthetics, Local/adverse effects
• Nerve Block/adverse effects
• Postoperative Complications
• Analgesics
• Ultrasonography, Interventional
• Analgesics, Opioid
• Randomized Controlled Trials as Topic

• 2021GY11 Huzhou Municipal Science and Technology Bureau

• analgesia
• dogs
• hemilaminectomy
• retrolaminar block
• spinal surgery

• Local anesthesia
• osteoporotic vertebral compression fracture
• percutaneous kyphoplasty
• thoracic paravertebral block
• ultrasound-guided

• Median effective volume
• sequential trial
• thoracic paravertebral nerve block
• thoracoscopic radical surgery
• ultrasound-guided

• Humans
• Ropivacaine
• Pain, Postoperative
• Ultrasonography, Interventional/methods
• Nerve Block/methods
• Thoracoscopy
• Lung Neoplasms/surgery

Various techniques for regional anesthesia and analgesia of the thorax are currently being used in clinical practice. A recent international consensus has anatomically classified paraspinal blocks in the thoracic spinal region into the following four types: paravertebral, retrolaminar, erector spinae plane, and intertransverse process blocks. These blocks have different anatomical targets; thus, the spreading patterns of the injectates differ and can consequently exhibit different neural blockade characteristics. The paravertebral block directly targets the paravertebral space just outside the neuraxial region and has an analgesic efficacy comparable to that of the epidural block; however, there are multiple potential risks associated with this technique. Retrolaminar and erector spinae plane blocks target the erector spinae plane on the vertebral lamina and transverse process, respectively. In anatomical studies, these two blocks showed different injectate spreading patterns to the back muscles and the fascial plane. In cadaveric studies, paravertebral spread was identified, but variable. However, numerous clinical reports have shown paravertebral spread with erector spinae plane blocks. Both techniques have been found to reduce postoperative pain compared to controls; however, the results have been more inconsistent than with the paravertebral block. Finally, the intertransverse process block targets the tissue complex posterior to the superior costotransverse ligament. Anatomical studies have revealed that this block has pathways that are more direct and closer to the paravertebral space than the retrolaminar and erector spinae plane blocks. Cadaveric evaluations have consistently shown promising results; however, further clinical studies using this technique are needed to confirm these anatomical findings.

• erector spinae plane block
• nerve block
• pain management
• paraspinal block
• paravertebral block
• paravertebral space
• retrolaminar block

• anatomy
• costotransverse joint
• costovertebral joint
• endothoracic fascia
• parietal pleura
• spine
• spine surgery
• thoracic spine

This review focuses on describing the procedural and anesthetic management of patients undergoing nonintubated video-assisted thoracoscopy surgery.

Most thoracic surgery is performed under general endotracheal anesthesia with either a double lumen endotracheal tube or a bronchial blocker. In an attempt to lessen the incidence and severity of postoperative complications, the nonintubated video-assisted thoracoscopic technique was developed, where the surgical procedure is performed under regional anesthesia with sedation. Currently, this technique is recommended for the elderly and in patients with severe cardiopulmonary disease who are at increased risk of complications after general anesthesia. It is the role of the anesthesia team to assist in the decisions whether the patient is a candidate and which block should be performed and to carefully monitor these patients in the operating room.

Nonintubated video-assisted thoracic surgery is an emerging technique with the goal of reducing postoperative complications. The anesthetic technique is highly variable and ranges from general anesthesia with a laryngeal mask airway with a truncal block to thoracic epidural anesthesia with minimal to no block. It is important to have excellent communication with the surgical team and the patient to ensure a safe, successful procedure.

• Artificial pneumothorax
• Erector spinae plane block
• Intercostal block
• Paravertebral block
• Pendular respiration
• Serratus anterior block
• Thoracic epidural analgesia
• Uniportal technique
• Video-assisted thoracic surgery

To date, there is no definitive evidence for the analgesic effects and side effects of thoracic epidural anesthesia (TEA) versus thoracic paravertebral block (TPVB) after thoracoscopic surgery. In this study, we conducted a meta-analysis of published randomized clinical trials (RCTs) to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery.

We systematically searched RCTs published by October 26, 2020, in PubMed, EMBASE, and Cochrane library and conducted a meta-analysis to analyze the analgesic effects of TEA versus TPVB after thoracoscopic surgery. The primary measure was postoperative pain score, and the secondary measures were postoperative 24-hour usage of opioids, hypotension, postoperative nausea, and vomiting.

A total of 458 patients from five RCTs were included in this study. After thoracoscopic surgery, the numerical rating scale (NRS) score for resting pain was higher in the TPVB group than in the TEA group at 1–2 hours and 4–6 hours after surgery (MD = 0.44, 95% CI = 0.24 to 0.64, P < 0.0001, I2 = 0%; MD = 0.47, 95% CI = 0.23 to 0.70, P < 0.0001, I2 = 0%). The postoperative 24-hour usage of morphine was higher in the TPVB group than in the TEA group (SMD = 0.67; 95% CI = 0.03 to 1.31; P = 0.04; I2 = 84%). The incidence of hypotension was significantly lower in the TPVB group than in the TEA group (OR = 4.52; 95% CI = 2.03 to 10.10; P = 0.0002; I² = 0%). No significant between-group difference was observed in postoperative nausea and vomiting (PONV).

Compared with TPVB, TEA provides statistically significant but clinically unimportant short-term benefits following thoracoscopic surgery.

• meta-analysis
• thoracic epidural anesthesia
• thoracic paravertebral block
• thoracoscopic surgery

Spinal pain (SP) is a common condition that has a major negative impact on a patient’s quality of life. Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice. This clinical expert consensus describes the purpose, significance, implementation methods, indications, contraindications, and techniques of ultrasound-guided injections. This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.

• Spinal pain
• Ultrasound-guided injections
• Facet joints
• Spinal nerve roots
• Posterior spinal nerve
• Experts consensus

Thoracic paravertebral block (TPVB) entails injecting a local anesthetic inside the thoracic paravertebral space (TPVS). Loss of resistance to air injection (air-LOR) was the first technique described in humans to locate the TPVS. To date, no study has investigated the spread of any substance after injection into the TPVS using the air-LOR technique nor has described the cranial and caudal limits of the space.

To identify the boundaries of the TPVS, to determine whether the air-LOR technique is reliable for the identification of the TPVS and to examine the relationship between the volume of injectate and its spread.

After a preliminary phase, the thorax of five cat and five dog cadavers was accessed and eviscerated. After TPVS probing, the polyurethane foam was injected, and the cranial and caudal borders were recorded after its maximum spread. Different volumes of a mixture of new methylene blue and ioversol were injected in the TPVS after its localization with a Tuohy needle and air-LOR technique in fourteen dog and six cat cadavers. Lateral radiographs of the vertebral column were used to document needle positioning, spread pattern and extension. The thorax of these subjects was then accessed and eviscerated to observe and record the spread of the mixture.

Injecting a dye into the TPVS, localized by an air-LOR technique, resulted in multi-segmental and often bilateral subpleural staining of paravertebral, intercostal, and dorsal mediastinal structures in dog and cat cadavers. The lateral radiographs most often showed a mixed cloud-like and linear spread pattern, which could be a predictor of the longitudinal spread of the dye. The foam injected into the TPVS at the cranial and the caudal level revealed anatomical communication with the cervical, axillar, and lumbar paravertebral regions.

TPVS localization by air-LOR technique and injection results in a longitudinal multi-segmental spread in dog and cat cadavers. The communication of the TPVS with the axillary and lumbar regions could be of clinical interest for the brachial plexus and the lumbar intercostal nerve blocks in a clinical setting.

• Loss of resistance
• Pet
• Regional anesthesia
• Thoracic paravertebral block
• Thoracic paravertebral space

• Analgesia
• Sustained epidural block
• Sustained paravertebral block
• Thoracoscopic lung cancer operation
• Thoracoscopic surgery

Ultrasound-guided thoracic paravertebral block (TPVB) is an established means for providing postoperative analgesia in thoracic surgery. However, there are conflicting results regarding the efficacy of post-thoracotomy pain management of ultrasound-guided TPVB when compared with that using traditional landmark approach. We therefore conducted a comparative study to evaluate the analgesic efficacy of TPVB when pressure measurement during needle advancement is combined with an ultrasound-guided approach.

The patients scheduled for lobectomy through thoracotomy were randomly allocated to receive either the ultrasound-guided approach only group (U group) or the ultrasound-guided approach combined with pressure measurement group (UP group) (n = 36 per group). Before thoracic muscle closure, 0.375% ropivacaine (20 mL) was administered as a bolus, followed by a continuous infusion of 0.2% ropivacaine (0.1 mL/kg/hr) in both groups. Postoperative pain was assessed using the visual analogue scale (VAS) pain score while resting and coughing. Local anesthetics and pethidine usage and sensory block area were also evaluated.

The UP group showed significantly lower VAS scores, local anesthetics and pethidine usage, and a wider sensory block area than the U group.

A combined technique with ultrasound guidance and pressure measurement provided a superior analgesic effect over that of an ultrasound-guided approach alone for the management of post-thoracotomy pain.

• postoperative analgesia
• pressure measurement
• thoracic surgery
• ultrasound-guided
• visual analogue scale

• Caudal thoracic paravertebral catheter
• Dog
• Regional anesthesia
• Ultrasound guided

Single injections in the anterior region of the thoracic paravertebral space (TPVS) have been reported to generate a multisegmental longitudinal spreading pattern more frequently than those in the posterior region of the TPVS. In this trial, we examined the hypothesis that a continuous thoracic paravertebral block (TPVB) administered through a catheter inserted into the anterior region of the TPVS allows a wider sensory block dispersion. Fifty consecutive patients undergoing video-assisted thoracic surgery were enrolled. Before the surgery, an infusion catheter was inserted into the TPVS through a needle placed adjacent to either the parietal pleura (group A) or internal intercostal membrane (group P) using an ultrasound-guided intercostal transverse approach according to a randomized allocation schedule. A chest radiograph was obtained postoperatively after injection of 10 mL of radiopaque dye through the catheter. Thereafter, 20 mL of 0.375% levobupivacaine was injected via the catheter, followed by commencement of continuous TPVB with 0.25% levobupivacaine at 8 mL/h. The primary outcome was the number of blocked dermatomes at 24 h after surgery. The secondary outcomes included radiopaque dye spreading patterns, the number of segments reached by the radiopaque dye, the number of blocked dermatomes at 2 h after surgery, and pain scores. The median (interquartile range [range]) number of blocked dermatomes 24 h after surgery was 3 (2.75–4 [1–6]) in group A (n = 22) and 2 (1.5–3 [0–7]) in group P (n = 25; p = 0.037). No significant differences in the other outcomes were found between the groups. In conclusion, a continuous TPVB administered using a catheter supposedly inserted into the anterior region of the TPVS allows a wider sensory block dispersion than a catheter inserted into the posterior region of the TPVS. This trial is registered with the UMIN Clinical Trials Registry (UMIN000018578).