Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: A randomised controlled trial.
Aged
Analgesics, Opioid
/ administration & dosage
Anesthetics, Local
/ administration & dosage
Female
Fentanyl
/ administration & dosage
Humans
Infusion Pumps
Infusions, Parenteral
/ instrumentation
Levobupivacaine
/ administration & dosage
Male
Middle Aged
Nerve Block
/ methods
Pain Management
/ instrumentation
Pain Measurement
Pain, Postoperative
/ diagnosis
Prospective Studies
Spinal Nerves
/ diagnostic imaging
Thoracic Surgery, Video-Assisted
/ adverse effects
Thoracic Vertebrae
/ diagnostic imaging
Treatment Outcome
Ultrasonography, Interventional
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
pubmed:
22
1
2019
medline:
4
12
2019
entrez:
22
1
2019
Statut:
ppublish
Résumé
The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block. A randomised controlled study. A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study. Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine. The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised. There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg versus 6 [3.5 to 9] μg kg respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group. Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia. UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378).
Sections du résumé
BACKGROUND
The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown.
OBJECTIVE
The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block.
DESIGN
A randomised controlled study.
SETTING
A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study.
INTERVENTION(S)
Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine.
MAIN OUTCOME MEASURES
The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised.
RESULTS
There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg versus 6 [3.5 to 9] μg kg respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group.
CONCLUSION
Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia.
TRIAL REGISTRATION
UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378).
Identifiants
pubmed: 30664012
doi: 10.1097/EJA.0000000000000945
doi:
Substances chimiques
Analgesics, Opioid
0
Anesthetics, Local
0
Levobupivacaine
A5H73K9U3W
Fentanyl
UF599785JZ
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM