Paravertebral blocks

PVB remains an underused block. It is easy to perform reliable and effective blocks for a wide variety of applications both for acute or chronic pain. As evidence continues to be published showing the advantages of PVB versus traditional methods of pain control, it is hoped that PVB will become part of the standard repertoire of blocks used in teaching hospitals and in private practice.     

Paravertebral blocks

Paravertebral blocks have been demonstrated to represent an interesting alternative to epidural, especially for the management of perioperative and trauma pain. Initially performed mostly as single-shot blocks for breast surgery, thoracotomy, and hernia repairs in adults and children, presently these blocks are also used for placement of a paravertebral catheter, either unilateral or bilateral. Although complications associated with the performance of these blocks are infrequent, the use of ultrasound-guided approaches, which allow performing the block under direct vision, is becoming the standard in most groups performing these blocks routinely.     

Paravertebral anesthesia and analgesia

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -     

Paravertebral glomangioma mimicking a schwannoma

Glomus tumors are rare benign neoplasms usually arising from soft tissues. Surgical removal seems to be the best treatment. Here, we report the case of a 52-year-old female patient referred for chronic back pain, revealing a thoracic paravertebral tumor with no osseous extension. After surgical removal, this tumor turned out to be a glomangioma. Differential diagnosis with other more frequent tumors, such as schwannoma, is particularly difficult. A review of the relevant literature will be presented. A better knowledge of the natural history of those tumors, as well as the therapeutic options available, are necessary for spinal surgeons who may encounter such presentations.     

Paravertebral block: An overview

Since the reintroduction of paravertebral block into clinical practice in 1980s, there has been an increasing interest in the technique as it provides high quality analgesia, a favourable side-effect profile, and may facilitate day care surgery and decrease hospital stay and cost. Over the last decade, there have been advances in the technique and expansion of its applications. Current evidence supports its safety and efficacy when used alone for surgical anaesthesia or combined with general anaesthesia for postoperative analgesia. This article reviews the techniques, applications and complications of thoracic and upper lumbar PVB in adult patients.     

Paravertebral analgesia in thoracic surgery

Managing postoperative pain from thoracotomy is one of the greatest challenges anesthesiologists face in daily practice. Proper management is assumed to improve the patient's prognosis. The thoracic paravertebral block, following its rediscovery, is being used with increasing frequency and success for both surgery and recovery from thoracotomy, challenging the supremacy of thoracic epidural analgesia, which to date has been considered the gold standard. We describe the history, anatomy, techniques and complications of the thoracic paravertebral block and review published randomized controlled trials comparing the thoracic paravertebral block to placebo and to epidural analgesia. In view of published evidence, it seems that the thoracic paravertebral block may replace the thoracic epidural technique as the gold standard for providing analgesia for patients undergoing thoracotomy.     

Paravertebral thoracic block—a reappraisal

An accurate, simple and safe method, based upon cadaver studies, of obtaining a thoracic paravertebral block, suitable for repeated administration by catheter or for permanent accurate neurolytic block, and which carries significant advantages over intercostal or epidural block, is described in theory and practice.     

Paravertebral block for breast cancer surgery

Purpose

Major breast cancer surgery is associated with a high incidence of postoperative nausea, vomiting and pain. Regional anaesthesia, with intraoperative sedation, would seem an ideal alternative to general anaesthesia for this type of surgery. We report our initial experience using paravertebral blocks (PVB) to provide anaesthesia for major breast surgery.

Methods

Twenty-five patients agreeing to have surgery performed under paravertebral blocks were studied. Procedures performed varied from simple lumpectomy with axillary dissection to modified radical mastectomy with axillary dissection. During monitored sedation, blocks opposite spinous processes of C₇– T₆ were performed using bupivacaine 0.5% with epinephrine, 3– 4 ml per segment. Patients were evaluated for 72 hr and were requested to document:(i) when sensation returned (ii) incidence and frequency of nausea or vomiting (iii) degree of discomfort and medication taken.

Results

Twenty patients had blocks that required no supplementation. Five patients had blocks that were incomplete. No complications were attributed to the blocks. Post-operatively, patients with successful blocks had minimal nausea, vomiting and pain. No patients found the procedure unsatisfactory. Patients with successful blocks were all very satisfied.

Conclusion

Our initial results show that PVB for breast cancer surgery can be successfully performed in a majority of patients with few side effects. All patients with successful blocks were returned to the ambulatory care unit, bypassing the recovery room. That breast cancer surgery under regional anaesthesia can be safely performed as an ambulatory procedure has the potential for accomplishing major cost-saving.