Thoracic paravertebral analgesia

Richardson, Jonathan; Sabanathan, S

doi:10.1111/j.1399-6576.1995.tb04219.x

Cited by 91 publications

(50 citation statements)

References 70 publications

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“…We point out that severe complications can be as high as 5% with the blind traditional paravertebral technique. 7,20 In this report, we suggest that utilizing ultrasoundguidance will further simplify and significantly improve the lamina approach described by Pfeiffer. Ultrasound imaging of the vertebral lamina is easy and reproducible.…”

Section: Discussionmentioning

confidence: 91%

The ultrasound-guided retrolaminar block

Voscopoulos

Palaniappan

Zeballos

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Paravertebral blocks have gained in popularity and offer the possible benefit of reduced adverse effects when compared with epidural analgesia. Nevertheless, pulmonary complications in the form of inadvertent pleural puncture are still a recognized risk. Also, the traditional paravertebral blocks are often technically difficult even with ultrasound guidance and constitute deep noncompressible area injections. We present our experience with the first three patients receiving ultrasound-guided retrolaminar blocks for managing the pain associated with multiple rib fractures. Clinical features The vertebral laminae are identified by ultrasound imaging in a paramedian sagittal plane by sequentially visualizing the pleura and ribs, transverse processes, and the corresponding laminae (from lateral to medial). The block needle is guided to contact the lamina, and the local anesthetic injectate is visualized under real-time imaging. A catheter is inserted and used for continuous analgesia. In three consecutive patients, verbal rating scale (VRS) pain scores were reduced from 10/10 to less than 5/10, and no technical difficulties, complications, or adverse effects were encountered. Conclusions Successful analgesia was achieved in all three cases utilizing continuous infusion and intermittent boluses with ultrasound-guided retrolaminar blocks. These results show the feasibility of this approach for patients with multiple rib fractures. RésuméObjectif Les blocs paravertébraux ont gagné en popularité et offrent l'avantage de réduire potentiellement les effets secondaires comparativement à l'analgésie péridurale. Toutefois, les complications pulmonaires, sous forme de ponction pleurale involontaire, demeurent un risque bien connu. En outre, les blocs paravertébraux conventionnels sont souvent difficiles à réaliser d'un point de vue technique et ce, même sous échoguidage, étant donné qu'il s'agit d'injections profondes réalisées dans des zones non compressibles. Nous rapportons notre expérience auprès des trois premiers patients à recevoir un bloc rétrolaminaire échoguidé pour la prise en charge de la douleur associée à une fracture multiple des cô tes. É léments cliniques Les lames vertébrales sont identifiées par ultrason dans un plan sagittal paramédian en visualisant la plèvre et les cô tes, les apophyses transverses, et les lames correspondantes (des lames latérales aux médiales) séquentiellement. L'aiguille du bloc est guidée jusqu'à ce qu'elle atteigne la lame, et l'anesthésique local injecté est visualisé par imagerie en temps réel. Un cathéter est inséré et utilisé pour l'analgésie en continu. Chez trois patients consécutifs, les scores de douleur sur une échelle visuelle ont baissé de 10/10 à Author contributions Christopher Voscopoulos, Dhamodaran Palaniappan, Jose Zeballos, Kamen Vlassakov, and Hanjo Ko performed blocks. Christopher Voscopoulos, Dhamodaran Palaniappan, Jose Zeballos, Kamen Vlassakov, Hanjo Ko, Michael Kapottos, David Janfaza, and Agnieszka Trzcinka contributed to writing the paper. ...

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Section: Discussionmentioning

confidence: 91%

The ultrasound-guided retrolaminar block

Voscopoulos

Palaniappan

Zeballos

et al. 2013

Can J Anesth/J Can Anesth

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“…[5] The technique provided good operative anesthesia for major chest wall procedures as well as good postoperative analgesia. [6] Benefits include, reduction in postoperative nausea and vomiting and potential for ambulatory discharge.…”

Section: Discussionmentioning

confidence: 99%

“…Although accidental pleural puncture is rare, [10] paravertebral block is still considered potentially dangerous by many anesthetist. [5] Using ultrasound to visualize anatomical landmarks, it will be possible to improve the safety of the block. Ultrasound imaging not only helps to determine needle insertion sites, but also provides information about the depth to the paravertebral space.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound guided continuous paravertebral block in a patient with coronary heart disease and sleep apnea syndrome

Esen

Bircan

Çınar

et al. 2016

Agri

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JANUARY 2016 42 ÖzetBu olguda, 77 yaşında ciddi koroner arter hastalığı öyküsü olan, ultrason eşliğinde sürekli paravertebral blok tekniğiyle radikal mastektomi ve aksiller lenf nodu diseksiyonu uygulanan bir hasta sunuldu. Genellikle aksiller diseksiyon ve radikal mastektomi genel anestezi altında uygulanan bir cerrahi prosedür olup endotrakeal entübasyon gerektirir. Koroner arter hastalığı ve uyku apne sendromu olan hastalarda genel anestezi yüksek risklidir. Ultrason eşliğinde sürekli paravertebral blok tekniği basit ve güvenli bir anestezi alternatifi olduğu kadar minimal yan etkiyle ameliyat sonrası analjezi de sağlamaktadır.Anahtar Kelimeler: Koroner arter hastalığı; mastektomi; ultrason eşliğinde sürekli paravertebral blok. SummaryThe case of a 77-year-old patient with severe coronary heart disease who underwent radical mastectomy with axillary lymph node dissection by ultrasound-guided continuous paravertebral block (CPVB) is described in the present report. Radical mastectomy with axillary dissection is a surgical procedure that necessitates endotracheal intubation and is usually performed under general anesthesia, which carries heightened risk for patients with coronary heart disease (CHD) and sleep apnea syndrome (SAS). Ultrasound-guided CPVB is a simple and safe alternative technique that allows for the use of anesthesia and postoperative analgesia with minimal side effects.

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“…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]. LA like bupivacaine 0.0625% or ropivacaine 0.2% at the rate of 3-10 ml/hour in infusion form are found very effective in providing post operative analgesia [9].…”

Section: Discussionmentioning

confidence: 99%