JOPIC
Journal of Pulmonology and Intensive Care

The JoPIC is an independent-unbiased, peer-reviewed, and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, surgical techniques, differential diagnoses, editorial opinions, letters to the editor, and educational papers in pulmonology, thoracic surgery, occupational diseases, allergology, and intensive care medicine. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

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Case Report
Combined paravertebral and erector spinae plane block in non-intubated video-assisted thoracoscopic wedge resection: a case report
Abstract
Thoracic surgery is often performed under general anesthesia, with intubation required. Less invasive surgical and anesthesiology approaches, such as a combination of video-assisted thoracic surgery (VATS) and regional nerve blocks, have been utilized to facilitate early recovery. In this case report, a patient undergoing VATS will be presented using thoracic paravertebral block (TPVB) and erector spinae plane blocks (ESPB) as the primary anesthesia approach. A twenty-eight-year-old male patient with no known comorbidity had been evaluated for VATS to undergo wedge resection of the right middle lobe due to non-resolving repeated pneumothorax. As the patient had bullous lung presence at the contralateral side as well, invasive ventilation was deemed risky, and, as an alternative approach, real-time ultrasound-guide TPV and ESPB block were performed with intravenous midazolam 2 mg and fentanyl 50 mcg utilized to prevent anxiety and pain control. A total of 20 ml bupivacaine and 10 mL 2% lidocaine were used for nerve blocks and for maintenance of sedation; 2 mg midazolam, 50 mg ketamine, 50 mcg fentanyl, and 150 mg propofol were used within 90 minutes of operation. After VATS, the patient was admitted to the surgical intensive care unit, and no complication was observed post-operatively, with a successful transfer to the ward afterward. Maintenance of an unproblematic perioperative period is as paramount as the surgery itself. A combination of protocols, with the limitation of post-operative opioid usage by sedation and less invasive surgical methods, such as non-intubated VATS being presented in this case report, allows an earlier recovery period and less complication by preserving lung function. TPV and ESPB, in this case, granted exclusion of intubation, less invasive to thoracic epidural anesthesia, and control of possible complications due to an already bullous lung.

Keywords : Thoracic paravertebral block, erector spinae plane block, video-assisted thoracic surgery

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1. Moningi S, Patki A, Padhy N, Ramachandran G. Enhanced recoveryafter surgery: An anesthesiologist’s perspective. J Anaesthesiol ClinPharmacol. 2019;35(1):5-13.
2. Dinic VD, Stojanovic MD, Markovic D, et al. Enhanced recovery inthoracic surgery: a review. Front Med. 2018;5(1):5-14.
3. Pincus E. Regional anesthesia: an overview. AORN J. 2019;110(3):263-272.
4. Moorthy A, Eochagáin A, Dempsey E, et al. Postoperative recovery with continuous erector spinae plane block or video-assisted paravertebralblock after minimally invasive thoracic surgery: a prospective,randomized controlled trial. Br J Anaesth. 2023;130(1):137-147. doi: 10.1016/j.bja.2022.07.051
5. Komatsu T, Kino A, Inoue M, et al. Paravertebral block for video-assisted thoracoscopic surgery: analgesic effectiveness and role in fast-track surgery. Int J Surg. 2014;12(9):936-939. doi: 10.1016/j.ijsu.2014.07.272
6. Liu L, Xin N, Zhang L, et al. Effects of ultrasound-guided erector spinaeplane block on postoperative analgesia and plasma cytokine levels afteruniportal VATS: a prospective randomized controlled trial. J Anesth.2021;35(1):3-9. doi: 10.1007/s00540-020-02848-x
7. Zengin M, Alagöz A, Sazak H, et al. Comparison of efficacy of erectorspinae plane block, thoracic paravertebral block, and erector spinaeplane block and thoracic paravertebral block combination for acutepain after video-assisted thoracoscopic surgery: a randomizedcontrolled study. Minerva Anestesiol. 2023;89(3):138-148.
8. Zengin M, Baldemir R, Ulger G, Sazak H, Alagoz A. Postoperativeanalgesic efficacy of thoracic paravertebralb and erectors plane blockcombination in video-assisted thoracic surgery. Cureus. 2021;13(6):15614.
9. Fu Z, Zhang Y, Zhou Y, et al. A comparison of paravertebral block,erector spinae plane block and the combination of erector spinae planeblock and paravertebral block for post-operative analgesia after video-assisted thoracoscopic surgery: a randomised controlled trial. J MinimAccess Surg. 2022;18(2):241.
10. Wen Y, Liang H, Qiu G, et al. Non-intubated spontaneous ventilationin video-assisted thoracoscopic surgery: ameta-analysis Eur JCardiothorac Surg. 2020;57(3):428-437. doi.org/10.1093/ejcts/ezz279
11. Kao MC, Lan CH, Huang CJ. Anesthesia for awake video-assistedthoracic surgery. Acta Anaesthesiol Taiwan. 2012;50(3):126-130.
12. Lin J, Liao Y, Gong C, et al. Regional analgesia in video-assistedthoracic surgery: a bayesian network meta-analysis. Front Med. 2022;9(6):842332.
13. Freise H, Van Aken HK. Risks and benefits of thoracic epiduralanesthesia. Br J Anaesth. 2011;107(6):859-868. doi.org/10.1093/bja/aer339
14. Mudannayake R, Martinez G, Bello I, Gimenez-Milà M. Non-intubatedthoracic surgery: a physiological approach. Arch Bronconeumol.2023;59(11):699-701.
15. Tacconi F, Pompeo E. Non-intubated video-assisted thoracic surgery:wdoes evidence stand? J Thorac Dis. 2016;8(4):364-375.
16. Alagoz A, Findik G, Sazak H, et al. Non-intubated video-assistedthoracoscopic surgery under combination of erector spinae plane blockand thoracic paravertebral block. BMC Anesthesiol. 2022;22(1):99.
Article available in :
Volume 2, Issue 3, 2024
Page : 65-68
https://doi.org/10.51271/JOPIC-0039
Article Information
Received : 10 Nis 2024
Accepted : 17 Tem 2024
Published : 15 Ağu 2024
Corresponding Author :

Mesher Ensarioğlu: Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkiye

[email protected]
Citation : Ensarioğlu M, Alagöz A, Tunç M, Sazak H. Combined paravertebral and erector spinae plane block in non-intubated video-assisted thoracoscopic wedge resection: a case report. J Pulmonol Intens Care. 2024;2(3):65-68.

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