Thoracal paravertebral block for breast surgery

Abstract

Torakal paravertebral blok (TPVB), dengeli hemodinamik yanıtla seyreden güvenli bir anestezi sağlaması, kateter aracılığıyla postoperatif ağrı kontrolüne imkân vermesi ve düşük yan etki profili nedeniyle genel anesteziye alternatif bir yöntemdir. Meme kanser cerahisi geçiren olgularda da aynı nedenle güvenle uygulanabilir bir yöntem olan TPVB çok az merkezde genel anestezi yerine uygulanmaktadır. Meme cerrahisi altında hastalar için yeterli bir anestezi sağlamasının yanında, unilateral somatik ve sempatik blokaj ile stabil bir hemodinamik denge, mükemmele yakın postoperatif ağrı kontrolü, minimal bulantı-kusma oranı, erken taburculuk ve düşük maliyet sağlar. Bu nedenle bazı merkezlerde meme cerrahileri için standart bir yöntem olan torakal paravertebral blok tüm anestezistler tarafından bilinmelidir. Torakal paravertebral bloğun genel anestezinin yerine uygulanacak bir yöntem olduğu kanaatindeyiz.

Single Needle Thoracic Paravertebral Block with Ropivacaine and Dexmeditomidine for Radical Mastectomy: Experience in 25 Cases

“…IV analgesia with 0.5-1 mcg/kg of fentanyl needed in four patients for mild discomfort intraoperatively. On radiological evaluation epidural spread has been reported by Beyaz et al resulting in bilateral local anaesthetic effects in a case of radical mastectomy conducted under TPVB [4]. Failure rates with TPVB is <13%.…”

“…More often it is utilized as an analgesic for breast carcinoma surgery, minimally invasive cardiac surgery, post thoracotomy pain, multiple rib fractures, acute herpetic neuralgia and other chronic pain conditions. Pusch et al reported effective anaesthesia with single injection of high volume of bupivacaine in TPVB for breast lump excision and mastectomies with axillary clearance [4][5][6]. Richardson et al suggested TPVB is a safe and effective technique and should be considered as an ideal alternative to general anesthesia for unilateral thoracic surgeries [7,8].…”

“…With TPVB there is minimal risk of neurological damage, being unilateral with sympathetic blockade incidence of postural hypotension is less unless the patient is hypovolemic and thus ambulatory discharge is possible. Patient's satisfaction is better as compared to thoracic epidural or general anaesthesia with lesser hospital stay and cost of treatment hence TPVB is considered as a safe alternative to epidural anaesthesia [3,4,8]. Davies et al in his meta-analysis found similar efficacy of pain relief with epidural and TPVB however failure rates and incidence of complication reported significantly higher in thoracic epidural group [8].…”

“…Vital monitoring started for ECG, PR, NIBP, SpO 2 and temperature. Under aseptic precautions single needle continuous TPVB at the level of T4 on the side of operation was given as described by Eason et al [1,[4][5][6]. The patient was given sitting position with head and neck in flexed position.…”

“…For breast surgery, the blocks are performed between T2 and T6 with either multiple injections or single shot/continuous technique that can be performed in sitting, lateral or prone positions [3,4]. Though it is an established technique for acute/ chronic and postoperative pain management for thoracic/ abdominal surgeries but it is less utilized as a sole regional anaesthetic technique.…”