Key result
A review of 15 articles demonstrated a low risk of bleeding for thoracic paravertebral block and minimal or absent risk for erector spinae plane block in patients on antithrombotic therapy.
Why the study?
The management of thoracic paravertebral block and erector spine plane block in patients on anticoagulant or antiplatelet therapy is based on limited clinical data, with scientific societies lacking strong detailed indications on their limitations.
Are thoracic paravertebral block and erector spinae plane block safe in patients treated with anticoagulant or antiplatelet therapy?
Are thoracic paravertebral block and erector spinae plane block safe in patients treated with anticoagulant or antiplatelet therapy?
TPVB and ESPB are reasonably safe regional anesthesia options in patients on antithrombotic therapy who are ineligible for epidural anesthesia, with ESPB potentially offering a safer profile.
Supports consideration of TPVB/ESPB when epidural contraindicated in antithrombotic patients; leaves open need for prospective safety confirmation.
INTRODUCTION: The management of thoracic paravertebral block (TPVB) and erector spine plane block (ESPB) in patients treated with anticoagulant or antiplatelet therapy is based on limited clinical data, mostly from single case reports. Scientific societies and organizations do not provide strong detailed indications about the limitations of these regional anesthesia techniques in patients receiving antithrombotic therapy. This review summarizes evidence regarding TPVB and ESPB in patients under antithrombotic therapy. EVIDENCE ACQUSITION: A literature review from PubMed/MEDLINE, EMBASE, Cochrane, Google Scholar and Web of Science databases was conducted from 1999 to 2022 to identify articles concerning TPVB and ESPB for cardio-thoracic surgery or thoracic procedures in patients under anticoagulant or antiplatelet therapy. EVIDENCE SYNTHESIS: A total of 1704 articles were identified from the initial search. After removing duplicates and not-pertinent articles, 15 articles were analyzed. The results demonstrated a low risk of bleeding for TPVB and minimal or absent risk for ESPB. Ultrasound guidance was extensively used to perform ESPB, but not for TPVB. CONCLUSIONS: Although the low level of evidence available, TPVB and ESPB are reasonably safe options in patients ineligible for epidural anesthesia due to antithrombotic therapy. The few published studies suggest that ESPB offers a risk profile safer than TPVB and the use of ultrasound guidance minimizes any complication. Since the literature available does not allow us to draw definitive conclusions, future adequately-powered trials are warranted to determine the indications and the safety of TPVB and ESPB in patients receiving anticoagulant or antiplatelet therapy.
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Nisi et al. (2023) conducted a review in Patients treated with anticoagulant or antiplatelet therapy (n=15). Thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) was evaluated on Risk of bleeding. A review of 15 articles demonstrated a low risk of bleeding for thoracic paravertebral block and minimal or absent risk for erector spinae plane block in patients on antithrombotic therapy.
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