Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks: A Randomized Controlled Study Comparing Dermatomal Spread
BACKGROUND AND OBJECTIVESThe objective of this study was to investigate the extent of dermatomal spread following an ultrasound-guided thoracic paravertebral block (PVB) when equal volumes of local anesthetic are injected at 1 versus 5 vertebral levels. METHODSSeventy patients undergoing a unilatera...
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| Veröffentlicht in: | Regional anesthesia and pain medicine 2017-09, Vol.42 (5), p.575-581 |
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| creator | Uppal, Vishal Sondekoppam, Rakesh V Sodhi, Parvinder Johnston, David Ganapathy, Sugantha |
| description | BACKGROUND AND OBJECTIVESThe objective of this study was to investigate the extent of dermatomal spread following an ultrasound-guided thoracic paravertebral block (PVB) when equal volumes of local anesthetic are injected at 1 versus 5 vertebral levels.
METHODSSeventy patients undergoing a unilateral mastectomy were randomized to receive either single or multiple injections of a PVB under real-time ultrasound guidance using a parasagittal approach. The patients in the single-injection group received a PVB at T3–T4 level with 25 mL of 0.5% ropivacaine and 4 subcutaneous sham injections. Patients in the multiple-injection group received 5 injections of a PVB from T1 to T5 level. Five milliliters of 0.5% ropivacaine was injected at each level. Evaluation of the sensory block was carried out 20 minutes following the completion of the PVB.
RESULTSThe median (interquartile range) dermatomal spread was not significantly different for the single-injection group (5 [4-6]) compared with the multiple-injection group (5 [5-6]), with a median difference of 0 segments (95% confidence interval, −1 to 0 segments; P = 0.22). The median time to performance of the single-injection PVB was shorter compared with the multiple-injection group (10 minutes), with a mean difference of −4 minutes (95% confidence interval, −6 to −3 minutes; P < 0.001).
CONCLUSIONSAn ultrasound-guided single-injection PVB provides equivalent dermatomal spread and duration of analgesia compared with a multiple-injection PVB. The single-injection technique takes less time to perform and hence may be preferred over a multiple-injection technique.The trial was registered prospectively at ClinicalTrials.gov (NCT02852421) on July 15, 2016. |
| doi_str_mv | 10.1097/AAP.0000000000000631 |
| format | Article |
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METHODSSeventy patients undergoing a unilateral mastectomy were randomized to receive either single or multiple injections of a PVB under real-time ultrasound guidance using a parasagittal approach. The patients in the single-injection group received a PVB at T3–T4 level with 25 mL of 0.5% ropivacaine and 4 subcutaneous sham injections. Patients in the multiple-injection group received 5 injections of a PVB from T1 to T5 level. Five milliliters of 0.5% ropivacaine was injected at each level. Evaluation of the sensory block was carried out 20 minutes following the completion of the PVB.
RESULTSThe median (interquartile range) dermatomal spread was not significantly different for the single-injection group (5 [4-6]) compared with the multiple-injection group (5 [5-6]), with a median difference of 0 segments (95% confidence interval, −1 to 0 segments; P = 0.22). The median time to performance of the single-injection PVB was shorter compared with the multiple-injection group (10 minutes), with a mean difference of −4 minutes (95% confidence interval, −6 to −3 minutes; P < 0.001).
CONCLUSIONSAn ultrasound-guided single-injection PVB provides equivalent dermatomal spread and duration of analgesia compared with a multiple-injection PVB. The single-injection technique takes less time to perform and hence may be preferred over a multiple-injection technique.The trial was registered prospectively at ClinicalTrials.gov (NCT02852421) on July 15, 2016.</description><identifier>ISSN: 1098-7339</identifier><identifier>EISSN: 1532-8651</identifier><identifier>DOI: 10.1097/AAP.0000000000000631</identifier><identifier>PMID: 28665874</identifier><language>eng</language><publisher>England: Copyright by American Society of Regional Anesthesia and Pain Medicine</publisher><subject>Aged ; Anesthetics, Local - administration & dosage ; Anesthetics, Local - adverse effects ; Confidence intervals ; Female ; Humans ; Injections ; Local anesthesia ; Mastectomy - adverse effects ; Middle Aged ; Nerve Block - adverse effects ; Nerve Block - methods ; Ontario ; Pain Measurement ; Pain Threshold - drug effects ; Pain, Postoperative - diagnosis ; Pain, Postoperative - etiology ; Pain, Postoperative - physiopathology ; Pain, Postoperative - prevention & control ; Regional anesthesia ; Time Factors ; Treatment Outcome ; Ultrasonic imaging ; Ultrasonography, Interventional</subject><ispartof>Regional anesthesia and pain medicine, 2017-09, Vol.42 (5), p.575-581</ispartof><rights>Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.</rights><rights>Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3331-38fc7acbf6fc32bc72ad5b6dea845c0bfe0fdef8c0a211e93e4cf803a40e5a563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28665874$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Uppal, Vishal</creatorcontrib><creatorcontrib>Sondekoppam, Rakesh V</creatorcontrib><creatorcontrib>Sodhi, Parvinder</creatorcontrib><creatorcontrib>Johnston, David</creatorcontrib><creatorcontrib>Ganapathy, Sugantha</creatorcontrib><title>Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks: A Randomized Controlled Study Comparing Dermatomal Spread</title><title>Regional anesthesia and pain medicine</title><addtitle>Reg Anesth Pain Med</addtitle><description>BACKGROUND AND OBJECTIVESThe objective of this study was to investigate the extent of dermatomal spread following an ultrasound-guided thoracic paravertebral block (PVB) when equal volumes of local anesthetic are injected at 1 versus 5 vertebral levels.
METHODSSeventy patients undergoing a unilateral mastectomy were randomized to receive either single or multiple injections of a PVB under real-time ultrasound guidance using a parasagittal approach. The patients in the single-injection group received a PVB at T3–T4 level with 25 mL of 0.5% ropivacaine and 4 subcutaneous sham injections. Patients in the multiple-injection group received 5 injections of a PVB from T1 to T5 level. Five milliliters of 0.5% ropivacaine was injected at each level. Evaluation of the sensory block was carried out 20 minutes following the completion of the PVB.
RESULTSThe median (interquartile range) dermatomal spread was not significantly different for the single-injection group (5 [4-6]) compared with the multiple-injection group (5 [5-6]), with a median difference of 0 segments (95% confidence interval, −1 to 0 segments; P = 0.22). The median time to performance of the single-injection PVB was shorter compared with the multiple-injection group (10 minutes), with a mean difference of −4 minutes (95% confidence interval, −6 to −3 minutes; P < 0.001).
CONCLUSIONSAn ultrasound-guided single-injection PVB provides equivalent dermatomal spread and duration of analgesia compared with a multiple-injection PVB. The single-injection technique takes less time to perform and hence may be preferred over a multiple-injection technique.The trial was registered prospectively at ClinicalTrials.gov (NCT02852421) on July 15, 2016.</description><subject>Aged</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Anesthetics, Local - adverse effects</subject><subject>Confidence intervals</subject><subject>Female</subject><subject>Humans</subject><subject>Injections</subject><subject>Local anesthesia</subject><subject>Mastectomy - adverse effects</subject><subject>Middle Aged</subject><subject>Nerve Block - adverse effects</subject><subject>Nerve Block - methods</subject><subject>Ontario</subject><subject>Pain Measurement</subject><subject>Pain Threshold - drug effects</subject><subject>Pain, Postoperative - diagnosis</subject><subject>Pain, Postoperative - etiology</subject><subject>Pain, Postoperative - physiopathology</subject><subject>Pain, Postoperative - prevention & control</subject><subject>Regional anesthesia</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography, Interventional</subject><issn>1098-7339</issn><issn>1532-8651</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kc1u1DAUhSMEoqXwBghFYsMmxY7jxGE3DFAqFVExLVvLsa-ZTJ04-IeqvAlvy0VTEHSBF_aR_Z2r63uK4iklx5T03cvV6vyY_L1aRu8Vh5SzuhItp_dRk15UHWP9QfEoxh0yomvah8VBLdqWoz4sfmzG-YuD6nTegU6jn8vPEGKO5Yfs0rj883IBejuPXzOU3paXLgUVfZ5NdZJHA6Y8V0F9g5BgCMqVr53XV_FVuSo_qdn4afyOyNrPKXjnUG5SNjd4MS0qYAvlGwiTSn5C62YJoMzj4oFVLsKT2_OouHz39mL9vjr7eHK6Xp1VmjFGKyas7pQebGs1qwfd1crwoTWgRMM1GSwQa8AKTVRNKfQMGm0FYaohwBVv2VHxYl93CR7_FpOcxqjBOTWDz1HSHkfa4CYQfX4H3fkcZuxO1pwznHbXcaSaPaWDjzGAlUsYJxVuJCXyV3QSo5N3o0Pbs9vieZjA_DH9zgoBsQeuvUsY0pXL1xDkFpRL2__X_gkz-KiV</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Uppal, Vishal</creator><creator>Sondekoppam, Rakesh V</creator><creator>Sodhi, Parvinder</creator><creator>Johnston, David</creator><creator>Ganapathy, Sugantha</creator><general>Copyright by American Society of Regional Anesthesia and Pain Medicine</general><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20170901</creationdate><title>Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks: A Randomized Controlled Study Comparing Dermatomal Spread</title><author>Uppal, Vishal ; Sondekoppam, Rakesh V ; Sodhi, Parvinder ; Johnston, David ; Ganapathy, Sugantha</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3331-38fc7acbf6fc32bc72ad5b6dea845c0bfe0fdef8c0a211e93e4cf803a40e5a563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Anesthetics, Local - adverse effects</topic><topic>Confidence intervals</topic><topic>Female</topic><topic>Humans</topic><topic>Injections</topic><topic>Local anesthesia</topic><topic>Mastectomy - adverse effects</topic><topic>Middle Aged</topic><topic>Nerve Block - adverse effects</topic><topic>Nerve Block - methods</topic><topic>Ontario</topic><topic>Pain Measurement</topic><topic>Pain Threshold - drug effects</topic><topic>Pain, Postoperative - diagnosis</topic><topic>Pain, Postoperative - etiology</topic><topic>Pain, Postoperative - physiopathology</topic><topic>Pain, Postoperative - prevention & control</topic><topic>Regional anesthesia</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography, Interventional</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Uppal, Vishal</creatorcontrib><creatorcontrib>Sondekoppam, Rakesh V</creatorcontrib><creatorcontrib>Sodhi, Parvinder</creatorcontrib><creatorcontrib>Johnston, David</creatorcontrib><creatorcontrib>Ganapathy, Sugantha</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing & Allied Health Database</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Science Journals</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Regional anesthesia and pain medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Uppal, Vishal</au><au>Sondekoppam, Rakesh V</au><au>Sodhi, Parvinder</au><au>Johnston, David</au><au>Ganapathy, Sugantha</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks: A Randomized Controlled Study Comparing Dermatomal Spread</atitle><jtitle>Regional anesthesia and pain medicine</jtitle><addtitle>Reg Anesth Pain Med</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>42</volume><issue>5</issue><spage>575</spage><epage>581</epage><pages>575-581</pages><issn>1098-7339</issn><eissn>1532-8651</eissn><abstract>BACKGROUND AND OBJECTIVESThe objective of this study was to investigate the extent of dermatomal spread following an ultrasound-guided thoracic paravertebral block (PVB) when equal volumes of local anesthetic are injected at 1 versus 5 vertebral levels.
METHODSSeventy patients undergoing a unilateral mastectomy were randomized to receive either single or multiple injections of a PVB under real-time ultrasound guidance using a parasagittal approach. The patients in the single-injection group received a PVB at T3–T4 level with 25 mL of 0.5% ropivacaine and 4 subcutaneous sham injections. Patients in the multiple-injection group received 5 injections of a PVB from T1 to T5 level. Five milliliters of 0.5% ropivacaine was injected at each level. Evaluation of the sensory block was carried out 20 minutes following the completion of the PVB.
RESULTSThe median (interquartile range) dermatomal spread was not significantly different for the single-injection group (5 [4-6]) compared with the multiple-injection group (5 [5-6]), with a median difference of 0 segments (95% confidence interval, −1 to 0 segments; P = 0.22). The median time to performance of the single-injection PVB was shorter compared with the multiple-injection group (10 minutes), with a mean difference of −4 minutes (95% confidence interval, −6 to −3 minutes; P < 0.001).
CONCLUSIONSAn ultrasound-guided single-injection PVB provides equivalent dermatomal spread and duration of analgesia compared with a multiple-injection PVB. The single-injection technique takes less time to perform and hence may be preferred over a multiple-injection technique.The trial was registered prospectively at ClinicalTrials.gov (NCT02852421) on July 15, 2016.</abstract><cop>England</cop><pub>Copyright by American Society of Regional Anesthesia and Pain Medicine</pub><pmid>28665874</pmid><doi>10.1097/AAP.0000000000000631</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Anesthetics, Local - administration & dosage Anesthetics, Local - adverse effects Confidence intervals Female Humans Injections Local anesthesia Mastectomy - adverse effects Middle Aged Nerve Block - adverse effects Nerve Block - methods Ontario Pain Measurement Pain Threshold - drug effects Pain, Postoperative - diagnosis Pain, Postoperative - etiology Pain, Postoperative - physiopathology Pain, Postoperative - prevention & control Regional anesthesia Time Factors Treatment Outcome Ultrasonic imaging Ultrasonography, Interventional |
| title | Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks: A Randomized Controlled Study Comparing Dermatomal Spread |
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