What does this research mean for the field?

Right-sided thoracic paravertebral blockade significantly prolongs QT and QTc intervals and decreases heart rate and blood pressure, whereas left-sided blockade produces no significant repolarization or hemodynamic changes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine the influence of thoracic paravertebral blockade on the QT interval and transmural dispersion of repolarization depending on the side of the block.

July 8, 2026Scientific ReportsOpen Access

Influence of thoracic paravertebral block on cardiac repolarization

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Unilateral breast surgery (n=60). Intervention: Thoracic paravertebral blockade (PVB) vs. Baseline (within-group) and contralateral side. Primary outcome: Change in uncorrected QT interval from baseline (95% CI 7.79-17.70, p=<0.001).

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Key result

Right-sided thoracic paravertebral block linked to ~13 ms QT prolongation, unlike left-sided blockade.

95% CI 7.79-17.70
P<0.001
n=60

Why the study?

Cardiac repolarization is influenced by autonomic regulation, but the specific influence of thoracic paravertebral blockade on QT interval and transmural dispersion of repolarization depending on the block side remained to be determined.

Does the side of thoracic paravertebral block with ropivacaine influence cardiac repolarization (QT interval and transmural dispersion of repolarization) in females undergoing unilateral breast surgery?

Comparison

Right-sided vs left-sided thoracic paravertebral block at the T3 level

Follow-up

6–11 min

Authors

ARAleksander P. RemeszUniversity Clinical Centre KDKamil S. DrucisUniversity Clinical Centre RORadosław OwczukUniversity Clinical Centre

Discussion

Member takes

Implication

Right-sided PVB was associated with QT prolongation; leaves open arrhythmia risk and need for randomized confirmation before practice change.

Key Points

To determine the influence of thoracic paravertebral blockade on the QT interval and transmural dispersion of repolarization depending on the side of the block.
Patients underwent thoracic paravertebral blockade at the T3 level using 0.5% ropivacaine.
A 12-lead ECG was recorded prior to blockade and 6–11 minutes post-block following confirmation of sensory loss across T1–T4 dermatomes.
Right-sided blockade caused significant prolongation of uncorrected QT (P < 0.001, 95% CI [7.79, 17.70]), QTcFe (P = 0.003, 95% CI [2.09, 11.72]), and QTcFm (P = 0.006, 95% CI [1.66, 10.97]), with no significant repolarization changes in the left group.
Right-sided blockade produced significant decreases in heart rate (P < 0.001, 95% CI [1.59, 6.25]) and mean arterial pressure (P < 0.015, 95% CI [0.72, 7.64]), whereas hemodynamics in the left group remained unchanged.
Neither group showed significant changes in Tp-e or the Tp-e/QT ratio, and no patient exceeded the 450 ms threshold for QT or QTc prolongation.

Study Design

Type

Observational (n=60)

Blinding

None

Randomization

None

Multicenter

Structured PICO

Population

60 female patients aged 18 and older scheduled for elective unilateral breast surgery who underwent right- or left-sided thoracic paravertebral blockade.

Intervention

Thoracic paravertebral block (PVB) at the T3 level on the operated side via a single injection of 0.5% ropivacaine (0.3 ml/kg, max 30 ml) without adjuvants.

Comparator

The study compared right-sided PVB versus left-sided PVB (patients were allocated according to the site of the operation without randomization).

Outcome

Changes in QT interval, corrected QT (QTc), Tp-e (transmural dispersion of repolarization marker), and Tp-e/QT ratio measured via 12-lead ECG before blockade and after confirmation of sensory block (6-11 minutes).surrogate

Main Result

p-value: p=<0.001

Right-sided, but not left-sided, thoracic paravertebral block with ropivacaine acutely prolongs the QT interval, highlighting the lateralization of cardiac autonomic innervation and suggesting a potential need for ECG monitoring during right-sided blocks.

Limitations

Lack of randomization and masking
Limited observation time (6-11 minutes)
Female-only population limits generalizability to males
Absence of ropivacaine serum concentration measurement
Accuracy of QT correction formulas is limited under conditions of heart rate changes
Short observation period
Limited availability of laboratory data for risk scores

Cite This Study

Remesz et al. (2026) conducted an observational in Unilateral breast surgery (n=60). Thoracic paravertebral blockade (PVB) vs. Baseline (within-group) and contralateral side was evaluated on Change in uncorrected QT interval from baseline (95% CI 7.79-17.70, p=<0.001). Right-sided thoracic paravertebral blockade significantly prolonged the uncorrected QT interval (95% CI of differences 7.79-17.70 ms, P<0.001) and decreased heart rate, whereas left-sided blockade produced no significant repolarization or hemodynamic changes.

synapsesocial.com/papers/6a4dec23d2ea289ef6284480 https://doi.org/10.1038/s41598-026-61196-0

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Implication

Right-sided PVB was associated with QT prolongation; leaves open arrhythmia risk and need for randomized confirmation before practice change.

Influence of thoracic paravertebral block on cardiac repolarization

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Influence of thoracic paravertebral block on cardiac repolarization

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider