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Paravertebral Block Unvisited territory

Karmakar M: Thoracic Paravertebral Block. Anesthesiology 2001;95:771-80.. Hugo Sellheim 1905. abdominal analgesiaKappis 1919. surgical anesthesiaEason

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Paravertebral Block Unvisited territory

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    1. Paravertebral Block Unvisited territory Adil Kamal MD American Board Of Anesthesiology Consultant Anesthesiology & Pain Management, APS director Anesthesia Residency Program Director King Faisal Specialist Hospital & Research Center Riyadh- Saudi Arabia 3/27/2012 1

    2. Karmakar M: Thoracic Paravertebral Block. Anesthesiology 2001;95:771-80. Hugo Sellheim 1905. abdominal analgesia Kappis 1919. surgical anesthesia Eason & Wyatt 1979. revisited PVB, cont cath. 3/27/2012 2

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    7. Indications Breast Surgery. - Bx ? MRM (T1-T6). - pt with chemotherapy induced CP disease. ( adriamycin cardiomyopathy, bleomycin pulmonary fibrosis). - Reduction mammoplasty.( ? Bilateral catheters). - breast augmentation.( ? bilateral catheters). 3/27/2012 7

    8. Coveney & colleagues. - 156 cases. - surgical anesthesia in 85 % with PVB,s alone, 91% with PVB,s & local anesthetic supp. - reduced incidence of PONV. - prolonged postoperative pain relief. - minimize narcotic use. Coveney E , Use of paravertebral block anesthesia in surgical management of breast cancer: experience in 156 cases. Ann Surg, 227(4) 1998.496-501. 3/27/2012 8

    9. Results PONV medications. Narcotic use. Discharge on D1. PVB,s GA 20 % 39 % 25 % 98 % 96 % 76 % 3/27/2012 9

    10. Postoperative analgesia for thoracic surgery & rib resection. - PVB catheter ( unilateral or bilateral)?. - according to level of incision.( T3 T8). 3/27/2012 10

    11. Postoperative analgesia for open or laparoscopic Cholecystectomy , Nephrectomy & appendectomy. - T6 T 11. 3/27/2012 11

    12. Inguinal, Ventral & umbilical hernia. - unilateral or bilateral block may be needed. - T 11- L2 for inguinal hernia. -B T7-T11 for ventral or Umbilical hernia. 3/27/2012 12

    13. ICBG ( T11- L3). Minimally invasive Cardiac Surgery. - unilateral or bilateral catheters. - T1-T7. 3/27/2012 13

    14. Rib Fracture ( block Vs catheter ?). Colostomy/ Iliostomy closure. Post Herpetic Neuralgia. Other chronic somatic malignant or non-malignant pain syndromes ( CRPS). - block Vs catheter. 3/27/2012 14

    15. Labor analgesia ( B T11)? analgesia for 1st stage of labor. Post operative analgesia for CS. -B T10- T12 Inguinal LN dissection ( T12- L2). Axillary dissection ( T1-T3). 3/27/2012 15

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    17. Technique Monitors. Resuscitation. O2. Sedation. position 3/27/2012 17

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    24. Mechanism of spread 15 cc ? 5 dermatomes (1-9) & 8 sympathetic ( 6-10). Preferential caudal spread. Contra lateral sympathetic blockade without sensory blockade ( B Horner's). Epidural spread in 70%. Contra lateral anesthesia. 3/27/2012 24

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    26. Absolute contraindications Pt refusal. Allergy to local anesthesia. Empyema. Infection at the site.( active herpes at the site). Tumor occupying PV space. 3/27/2012 26

    27. Relative Contraindications Coagulopathy. Therapeutic anticoagulation. - catheter may be appropriate? outside the central neuroaxis. Kyphoscoliosis. Previous thoracotomy ( adhesions). 3/27/2012 27

    28. Complications Failure rate 7-10 %. Infection. Bleeding. Intravascular injection / puncture (3.8%). Nerve injury. Epidural spread? hypotension ( 4.6%). 3/27/2012 28

    29. Spinal injection? High spinal, PDPH. Spread to the opposite side. Horner's syndrome. Pleural puncture (1.1 %). Pneumothorax (conservative management). Ipsilateral ulnar nerve blockade( T1). 3/27/2012 29

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