MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE
108 INSTITUTE OF CLINI CAL M EDICAL AND PHARMACEUTICAL S CIENCES
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TRAN THANH TRUNG
STUDYING ON THE ANALGESIC EFFICACY
AFTER LUNG SURGERY OF ULTRASOUND - GUIDED
CONTINOUS THORACIC PARAVERTEBRAL Bl OCK
WITH BUPIVACAIN - FENTANYL
Speciality: Anesthesiology
Code: 62.72.01.22
ABSTRACT OF MEDICAL PHD THESIS
Hanoi – 2019
THE THESIS WAS DONE IN: 108 INSTITUTE OF CLINICAL
MEDICAL AND PHARMACEUTICAL SCIENCES
Supervisor:
1. Ass. Prof. PhD. Trinh Van Dong
2. PhD. Dang Van Khoa
Reviewer:
1.
2.
3.
This thesis will be presented at Institute Council at: 108 Institute of
Clinical Medical and Pharmaceutical Sciences
Day Month Year
The thesis can be found at:
1. National Library of Vietnam
2. Library of 108 Institute of Clinical Medical and
Pharmaceutical Sciences
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INTRODUCTION
Lung surgery is one of the most painful thoracotomy, so
treatment of postoperative pain is needed. Many methods of pain
relief after lung surgery have been studied and applied, of which
epidural anesthesia is considered the "Gold Standard". However,
epidural anesthesia can cause hypotension, nerve damage, and is
contraindicated in patients with coagulopathy.
In recent years, thoracic paravertebral block as well as
ultrasound – guided thoracic paravertebral block is being accepted as
an alternative method for epidural anesthesia. It is becoming
increasingly common and receiving attention from anesthesiologists.
There has also been an increase in studies about thoracic
paravertebral block all over the world . However, methods
demonstrated in these studies are not homogeneous and the varying
results are causing much debate.
In Vietnam, there are only a few number of studies about
thoracic paravertebral block and no study about continuous thoracic
paravertebral block as well as the application of ultrasound in the
thoracic paravertebral block for pain after lung surgery. Therefore, we
conduct research on this topic with the aim of:
1. Comparing the postoperative analgesis effect of
ultrasound- guided continous thoracic paravertebral block with
epidural anesthesia using bupivacaine and fentanyl after lung
surgery.
2. Evaluating changes in circulation, respiratory and some
undesirable effects from these two methods of postoperative pain
relief.
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Chapter 1
OVERVIEW
1.1. Overview of lung surgery
1.1.1. Anatomy summary
1.1.2. Chest opening lines in lung surgery
1.1.3. Methods of lung surgery
1.1.3.1. According to surgery: including cutting one side of the
lungs, one lobe of the lung, two lobes of the lung, a part of the lobe of
the lung or part of the lung, peeled lung surgery.
1.1.3.1. In terms of surgery: including thoracotomy, video
assisted thoracic surgery (VATS) and endoscopic thoracic surgery.
1.2. Pain afte r lung sur gery
1.2.1. Definition of pain: Pain is an unpleasant sensory and
emotional experience associated with actual or potential tissue damage,
or described in terms of such damage.
1.2.2. The degree and duration of pain after lung surgery
1.2.3. Pathogenesis of pain after lung surgery
1.2.4. Effects of pain after lung surgery
1.2.5. Assess the levels of postoperative pain
There are many ways to assess postoperative pain levels,
such as examining glucose, cortisol levels, using subjective scales,
however, the VAS scale (Visual Analogue Scale) is more used.
1.3. Methods of pain relief after lung surgery
1.3.1. Systemic analgesia
1.3.2. Regional analgesia: continuous infusion of anesthetic
into the incision, intercostal nerve block, intrapleural analgesia,
epidural block and thoracic paravertebral block.
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1.3.3. Patient Control Analgesia (PCA)
1.3.4.Drug-free technique
1.4. Thoracic paravertebral block
1.4.1. Brief history
1.4.2. Anatomy of the thoracic paravertebral space
The thoracic paravertebral space is a wedge-shaped space that
lies on either side of the vertebral column. It is wider on the left than on
the right and ílimited by:
- Front wall: The parietal pleura forms.
- Posterior wall: The superior costotransverse ligament, which
extends from the lower border of the transverse process above to the
upper border of the transverse process below. This ligament connects
with intercostal membrane in the outer.
- Inner wall: the back side of the vertebral body, spinal disc and
split holes between the vertebrae.
1.4.3. Drugs used in the research
1.4.3.1. Bupivacain: There are many drugs used in the
paravertebral block but bupivacain is the most used. It is often combined
with epinephrin to detect mistaken injection into the blood vessels,
reduce circulatory
absorption, decrease peak plasma concentrations and
prolong analgesia.
1.4.3.2. Fentanyl: Used in the paravertebral block. The volume of
fentanyl concentration when combined with anesthesia is 1 to 2 µg/ml.
1.4.3.3. The spread of anesth esia in
the thoracic paravertebral space
Thoracic paravertebral block takes effect at the corresponding
segments marrow, or it may spread to the contiguous levels above and
below, causing motor, sensory and sympathetic blockade on one side,
including primary roots that dominate the abdominal segment of the
abdomen. Eason and Wyatt found that at least four intercostal spaces
could be covered by a single 15-ml injection of 0.375% bupivacain.