Update on paravertebral blocks

Abstract

The impact of paravertebral analgesia on cancer pain and prevention of metastasis could be huge once enough data have accumulated. The steady influx of data on PVBs has led to the resurgence of this block in almost every area of acute pain management.

Thoracic paravertebral blockade in breast surgery: Is pneumothorax an appreciable concern? A review of over 1000 cases

“…Therefore, the idea of pre‐emptive analgesia is more pertinent to prevent acute postoperative pain and sensitization . Thoracic paravertebral block (TPVB) is increasing in popularity, especially over the last two decades . TPVB is the technique of injecting local anesthetic into the paravertebral space, resulting in ipisilateral somatic and sympathetic nerve blockade, which has an effective impact on postoperative pain levels .…”

“…Despite numerous studies reporting the benefits of TPVB and the idea of pre‐emptive analgesia, there are safety concerns regarding iatrogenic injury . One of the major concerns is the risk of pneumothorax, as a serious complication . However, to date there is limited evidence to quantify this risk, or the clinical gravity of an iatrogenic injury.…”

“…2,3 Thoracic paravertebral block (TPVB) is increasing in popularity, especially over the last two decades. 4 TPVB is the technique of injecting local anesthetic into the paravertebral space, resulting in ipisilateral somatic and sympathetic nerve blockade, which has an effective impact on postoperative pain levels. 5 Already there is good evidence that shows that early control of acute postoperative pain can have a positive impact in reducing the development of chronic pain states (persistent postoperative pain).…”

“…5 Already there is good evidence that shows that early control of acute postoperative pain can have a positive impact in reducing the development of chronic pain states (persistent postoperative pain). 4,6 Postoperative pain is often poorly managed despite its high incidence. 7,8 This can ultimately result in central sensitization resulting in hyper-analgesia, chronic pain states, which can have substantial impact on quality of life.…”

“…1,13,14 One of the major concerns is the risk of pneumothorax, as a serious complication. 4,13 However, to date there is limited evidence to quantify this risk, or the clinical gravity of an iatrogenic injury. Recent, publications have advocated the use of ultrasound guidance over classical landmarks as an effective method to reduce the incidence of iatrogenic injury.…”