Bilateral thoracic paravertebral block: potential and practice

Abstract

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.

Thoracic Paravertebral Analgesia for Treatment Blunt Chest Trauma with Multiple Rib Fractures

“…Therefore, TPVB is a good option for pain control in blunt chest trauma patients with MRF. Studied in 100 adult patients who were paravertebral for postthoracotomy pain, Richardson concluded that pulmonary function as assessed by PEFR was also significantly better preserved in the TPVB group as compared to the thoracic epidural one [13].…”

Where now for thoracic paravertebral blockade?

“…The same cannot be said for PVB. Often, PVB is suggested as an alternative to TEA when the latter is contraindicated by coagulopathy or local infection [9,25,28]. With this in mind, it is concerning to note that in Luyet et als study (as has been reported previously [14]), on occasion, catheters inserted via a paravertebral approach are subsequently demonstrated to be located in the thoracic epidural space.…”

Regional Anesthesia for the Trauma Patient

“…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.…”