REVIEW   

Minerva Anestesiologica 2023 October;89(10):914-22

DOI: 10.23736/S0375-9393.23.17288-9

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

The safety of thoracic paravertebral block and erector spinae plane block in patients treated with anticoagulant or antiplatelet therapy. A narrative review of the evidence

Fulvio NISI ¹ ✉, Nicolò SELLA ², Guido DI GREGORIO ³, Marta LUBIAN ¹, Enrico GIUSTINIANO ¹, Giulio L. ROSBOCH ⁴, Eleonora BALZANI ⁵, Antonio TOSCANO ⁴, Giacomo STRANO ¹, Marco RISPOLI ⁶, Domenico MASSULLO ⁷, Silvia FIORELLI ⁷, Domenico SANTONASTASO ⁸, Vanni AGNOLETTI ⁸, Federico PICCIONI ¹

¹ Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; ² Institute of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy; ³ Department of Anesthesia and Intensive Care, ULSS6 Euganea, Cittadella, Padua, Italy; ⁴ Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy; ⁵ Department of Surgical Science, University of Turin, Turin, Italy; ⁶ Department of Anesthesia and Intensive Care, AO dei Colli - Monaldi Hospital, Naples, Italy; ⁷ Unit of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant’Andrea Hospital, Sapienza University, Rome, Italy; ⁸ Unit of Anesthesia and Intensive Care, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Forlì-Cesena, Italy

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.

KEY WORDS: Anesthesia, spinal; Hemorrhage; Platelet aggregation inhibitors