Bilateral thoracic paravertebral block: Potential and practice

Department of Pain and Anaesthetics, Bradford Royal Infirmary, Bradford BD9 6RJ, UK.
BJA British Journal of Anaesthesia (Impact Factor: 4.85). 02/2011; 106(2):164-71. DOI: 10.1093/bja/aeq378
Source: PubMed


Paravertebral nerve blocks (PVBs) can provide excellent intraoperative anaesthetic and postoperative analgesic conditions with less adverse effects and fewer contraindications than central neural blocks. Most published data are related to unilateral PVB, but its potential as a bilateral technique has been demonstrated. Bilateral PVB has been used successfully in the thoracic, abdominal, and pelvic regions, sometimes obviating the need for general anaesthesia. We have reviewed the use of bilateral PVB in association with surgery and chronic pain therapy. This covers 12 published studies with a total of 538 patients, and with varied methods and outcome measures. Despite the need for relatively large doses of local anaesthetics, there are no reports of systemic toxicity. The incidence of complications such as pneumothorax and hypotension is low. More studies on the use of bilateral PVB are required.

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    • "Paravertebral block is generally associated with low and acceptable side effects and complications. Hypotension, theoretic high blood concentrations of local anesthetic, and epidural or spinal spread of local anesthetic and pneumothorax are the possible controversial issues related to the bilateral PVB [10]. Ultrasound has been used to improve efficacy and reduce complications via real-time visualization of the intended anatomic space, surrounding structures, and the approaching needle. "
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    ABSTRACT: Paravertebral block is a unilateral analgesic technique that can provide adequate surgical anesthesia and great advantages in many types of surgery with a low side-effect profile. In this case we present combination of bilateral thoracic paravertebral block under ultrasound guidance with sedation which provides complete anesthesia and postoperative analgesia in a myasthenic patient undergoing cosmetic breast surgery. In myasthenic patients paravertebral blocks may be a better option for breast surgery with avoiding the need for muscle relaxants and opioids and risk of respiratory failure in postoperative period.
    09/2015; 2015(12):593282. DOI:10.1155/2015/593282
    • "Concomitant use of regional blocks can not only help to minimize pain, but also improves the pulmonary function and reduce narcotic requirement during the perioperative period.[34] Use of these techniques as part of a balanced anesthesia can help in preventing central sensitization and also decrease pulmonary complications.[5] Among the regional techniques such as intercostal nerve block, thoracic epidural, thoracic paravertebral block (PVB), and inter pleural block (IPB), the last two are commonly being used to provide intra and post-operative analgesia in patient undergoing modified radical mastectomy.[67] "
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    ABSTRACT: Paravertebral and inter pleural blocks (IPB) reduce post-operative pain and decrease the effect of post-operative pain on lung functions after breast surgery. This study was designed to determine their effect on lung functions and post-operative pain in patients undergoing modified radical mastectomy. A total of 120 American Society of Anesthesiologists physical status 1 and 2 patients scheduled to undergo breast surgery were randomly allocated to receive IPB (Group IPB, n = 60) or paravertebral block (PVB) (Group PVB, n = 60) with 20 ml of 0.5% bupivacaine pre-operatively. A standard protocol was used to provide general anesthesia. Lung function tests, visual analog scale (VAS) for pain at rest and movement, analgesic consumption were recorded everyday post-operatively until discharge. Lung functions decreased on 1(st) post-operative day and returned to baseline value by 4(th) post-operative day in both groups. VAS was similar in both groups. There was no significant difference in the consumption of opioids and diclofenac in both groups. Complete block was achieved in 48 patients (80%) in paravertebral group and 42 patients (70%) in inter pleural group. To conclude, lung functions are well-preserved in patients undergoing modified radical mastectomy under general anesthesia supplemented with paravertebral or IPB. IPB is as effective as PVB for post-operative pain relief. PVB has the added advantage of achieving a more complete block.
    Journal of Anaesthesiology Clinical Pharmacology 10/2013; 29(4):459-64. DOI:10.4103/0970-9185.119133
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    • "Although studies on the use of TPVC are still quite undeveloped, findings by Richardson et al, in a literature review on bilateral paravertebral blocks, found a favorable side effect profile. The high local anesthetic load associated with bilateral TPVC is a worthwhile consideration for analgesia in thoracic trauma patients [Richardson et al., 2011]. The clinician is faced with a number of questions about how to proceed with regional analgesia techniques for blunt thoracic trauma. "

    Pain Management - Current Issues and Opinions, 01/2012; , ISBN: 978-953-307-813-7
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