Transverse vs. parasagittal in-plane approaches in ultrasound-guided paravertebral block using a microconvex probe: A randomised controlled trial.

BACKGROUND: Several approaches have been proposed for ultrasound-guided thoracic paravertebral block, but the best approach remains unclear. OBJECTIVE: We compared two ultrasound-guided in-plane approaches using a microconvex probe, transverse and parasagittal. We assessed whether either approach would facilitate successful catheter placement in the paravertebral space. DESIGN: Randomised controlled trial. SETTING: University hospital, July 2015 to March 2016. PATIENTS: Sixty patients scheduled to undergo thoracotomy were randomly allocated into two groups. INTERVENTIONS: A microconvex probe was placed transversely between adjacent ribs (transverse) or sagittally between adjacent transverse processes (parasagittal). When the Tuohy needle reached the paravertebral space, a catheter was inserted to a depth of 4 cm. Then, 0.5-ml radiocontrast was injected through the catheter under fluoroscopy. MAIN OUTCOME MEASURES: The primary outcome was successful catheter placement in the paravertebral space; secondary outcomes were 0 to 100 mm visual analogue scale pain score and morphine consumption in the first 24 h. RESULTS: All patients received the allocated paravertebral block. Correct catheter placement occurred in 23 (77%) and 24 patients (80%) using the transverse (n=30) and parasagittal approaches (n=30), respectively (P = 1.00). Five patients were excluded due to changes in surgical procedure. Postoperative pain, represented by median [IQR] visual analogue scale score, was 19.5 [12 to 25] at rest and 55 [44 to 77] on movement with the transverse approach (n=28) vs. 22 [12 to 33.5] at rest and 59 [41.5 to 75] on movement with the parasagittal approach (n=27) (P = 0.57 at rest, P = 0.76 on movement). Median morphine consumption was 11.5 [5 to 21] and 11 [5 to 18] mg in the transverse and parasagittal approaches, respectively (P = 0.99). CONCLUSION: There were no clinically significant differences between approaches for continuous ultrasound-guided thoracic paravertebral block using a microconvex probe, and both approaches achieved a high rate of correct catheter placement. TRIAL REGISTRATION: UMIN Clinical Trials Registry identifier: UMIN000015988.

[Ultrasound-guided Truncal Block for Abdominal Surgery: Present and Future Perspectives].

Patients undergoing abdominal surgery can experi- ence severe pain due to the abdominal wall incision. Epidural anesthesia has been considered as the gold standard for perioperative analgesia in abdominal sur- gery. However, currently, many patients receive pro- phylactic anticoagulation therapy preoperatively with potential complications. For such cases, while epidural anesthesia is contraindicated, the use of ultrasound- guided peripheral nerve block is increasing. In abdomi- nal surgery, ultrasound-guided rectus sheath block and transversus abdominis plane block are commonly used for perioperative analgesia. The use of ultrasound ren- ders these block techniques safe and reliable. Cur- rently, a new abdominal peripheral nerve block, qua- dratus lumborum block, is gaining attention because it is thought to have a wider range of analgesia and a longer duration of effect As the analgesic properties of these blocks are limited in extent and duration, it is important to select the appropriate approach. Ultrasound-guided abdominal trunk block can con- tribute to perioperative multimodal analgesia.

Autografting followed by a reduced-intensity conditioning unrelated donor cord blood transplantation for a patient with refractory multiple myeloma: successful engraftment with minimal toxicity.

We report on a 59-yr-old man with recurrent multiple myeloma. To reduce treatment-related mortality, while retaining the cytoreductive effects of high-dose chemotherapy, as well as graft vs. myeloma effect, we used a reduced-intensity conditioning umbilical cord blood (CB) transplantation following high-dose chemotherapy with autologous stem cell transplantation support. This patient was engrafted rapidly and extramedullary toxicities were acceptable. Although he had local recurrence in the right calf on day +130 after the CB transplantation, the tumor was successfully treated with radiation therapy, and he is alive and well at present (day +480).