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[Thoracic Truncal Block : Trends and Future Perspectives].

Kaoru Hara, Shinichi Sakura

    Masui. the Japanese Journal of Anesthesiology
    |November 1, 2018
    PubMed
    Summary

    Peripheral nerve blocks, including paravertebral and Pecs blocks, offer promising analgesia for thoracic and breast surgery patients. Further randomized studies are needed to confirm their clinical usefulness and establish them as standard practice.

    Area of Science:

    • Anesthesiology and Pain Management
    • Thoracic Surgery
    • Oncologic Surgery

    Background:

    • Peripheral nerve blocks of the trunk are increasingly utilized in thoracic and breast surgery.
    • Existing research suggests paravertebral block offers comparable analgesia and improved hemodynamic stability to epidural anesthesia.
    • Paravertebral block may also reduce chronic pain and cancer recurrence/metastasis post-breast surgery.

    Purpose of the Study:

    • To review the current landscape of thoracic truncal blocks, including paravertebral, Pecs, intercostal, and retrolaminar blocks.
    • To evaluate the safety and efficacy of novel ultrasound-guided techniques like Pecs and intercostal nerve blocks.
    • To identify the need for further research to establish these blocks as standard clinical practice.

    Main Methods:

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    • Review of existing literature on thoracic truncal blocks.
    • Analysis of studies comparing paravertebral block with epidural analgesia.
    • Examination of case series on ultrasound-guided Pecs and intercostal nerve blocks.

    Main Results:

    • Paravertebral block demonstrates comparable analgesic effects and superior hemodynamic stability versus epidural anesthesia.
    • Pecs and intercostal nerve blocks, guided by ultrasound, show potential safety and efficacy but lack robust evidence.
    • Long-term benefits, such as chronic pain prevention and reduced cancer recurrence, are suggested for paravertebral blocks.

    Conclusions:

    • Thoracic truncal blocks represent a significant area of interest in perioperative management for thoracic and breast surgery.
    • While promising, Pecs and intercostal nerve blocks require further prospective randomized trials to validate their clinical utility.
    • The definitive role of these blocks in standard surgical practice remains to be determined.