Articles: nerve-block.
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Randomized Controlled Trial
Comparison of Thoracic Erector Spinae Plane Block With Thoracic Paravertebral Block for Pain Management in Patients With Unilateral Multiple Fractured Ribs.
Rib fractures occur most commonly because of blunt thoracic trauma and occur in up to 12% of all trauma patients. Adequate analgesia is paramount in enhancing pulmonary hygiene aimed at preventing atelectasis and pneumonia. Erector spinae plane block, one of the novel multiple thoracic ultrasound-guided techniques, can provide analgesia to both the anterior and posterior hemithorax, making it particularly useful in the management of pain after extensive thoracic trauma. ⋯ Ultrasound-guided thoracic erector spinae plane block was as effective as thoracic paravertebral block for pain alleviation in patients with unilateral multiple fractured ribs with a comparable duration of analgesic effect, reduction of opioid consumption, and stable hemodynamic profile. However, thoracic erector spinae plane block had the advantage of a lower adverse effect incidence. Clinicians could choose either of the 2 techniques according to their clinical experience and personal choice.
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Comment Letter Randomized Controlled Trial
Comment on "Transversus abdominis plane block with liposomal bupivacaine versus continuous epidural analgesia for major abdominal surgery: The EXPLANE randomized trial".
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Observational Study
Peak plasma concentration of total and free bupivacaine after erector spinae plane and pectointercostal fascial plane blocks.
Erector spinae plane blocks (ESPB) and pectointercostal fascial (PIFB) plane blocks are novel interfascial blocks for which local anesthetic (LA) doses and concentrations necessary to achieve safe and effective analgesia are unknown. The goal of this prospective observational study was to provide the timing (Tmax) and concentration (Cmax) of maximum total and free plasma bupivacaine after ESPB in breast surgery and after PIFB in cardiac surgery patients. ⋯ Total and free bupivacaine Cmax observed after ESPB and PIFB with 2 mg⋅kg-1 of bupivacaine with epinephrine 5 μg⋅mL-1 were five to twenty times lower than levels considered toxic in the literature.