MTP approach to paravertebral block as good as thoracic approach for analgesia in VATS patients

A recent study has revealed that for post operative analgesia for video assisted thoracoscopy surgeries (VATS), the effectiveness of mid transverse process (MTP) approach of the Paravertebral block (PVB) and conventional thoracic paravertebral approach are similar. This prospective study was conducted by Dr. Swathi KB and team from AIIMS and was published online in the Indian Journal of Anesthesia on 23 July 2021.

This clinical trial included 40 patients of 18 to 60 years, who were scheduled for VATS. They were randomly divided into two groups, conventional approach (group CP) and mid‑transverse process to pleura approach (group MP).

They evaluated both the groups for the analgesic consumption in the first 24 hours the Visual Analogue Scale (VAS) score, block performance time, dermatomal spread, hemodynamic parameters, patient satisfaction scores.

Highlights included in the study are:

The post-operative analgesic effects of continuous MTP block were equivalent to those of the traditional PVB method in VATS patients in the first 24 hours.

This study found that the MTP block group had equal block performance time, VAS ratings, rescue analgesic intake, and dermatomal spread, with less problems such as pleura puncture, making it a safe alternative to the traditional PVB method.

This study also discusses the effectiveness of the MTP block in a patient with numerous rib fractures, as well as the use of an intercostal drain and rib excision operation.

The Principal Investigator concluded saying "The MTP approach to the PVB is non-inferior to the conventional thoracic paravertebral approach for providing analgesia in patients undergoing VATS; hence it may be considered a safe alternative approach to the PVB."

Source

Swathi KB, Kamal M, Kumar M, Kumar R, Chhabra S, Bhatia P. Comparison of analgesic efficacy of the conventional approach and mid transverse process to pleura approach of the paravertebral block in video assisted thoracoscopy surgeries: A randomised controlled trial. Indian J Anaesth 2021;65:512-8