Analgesie der Achselhöhle durch Paravertebralkatheter in Laminatechnik

Abstract

A 62-year-old female suffered from therapy-resistant pain in the axilla after lymphadenectomy. The pain ranged from 8-10 on the numeric rating scale (NRS) despite multimodal pain therapy (non-steroid anti-rheumatics, opioids, physiotherapy, acupuncture). A paravertebral trial injection was performed preoperatively on the laminae of the thoracic vertebrae Th 2-Th 4. As the patient responded well, a paravertebral catheter was inserted close to Th 4 directly before the revision operation took place the following day. The case study describes the possibilities of eliminating pain segmentally in the axilla and an alternative technique to a paravertebral block (lamina technique).

The ultrasound-guided retrolaminar block: volume-dependent injectate distribution

“…Jűttner and Pfeiffer have claimed that the CTL is a porous structure and as such cannot be an obstacle for local anesthetic penetration into the PV space. 10 , 11 Since the CTL structure is no different from other ligaments, it is unlikely to be porous. However, the dorsal ramus of the spinal nerve exits posteriorly to innervate the paraspinal muscles through a medial aperture of the superior CTL.…”

“…Ultrasound-guided retrolaminar block is one of the newer and technically simpler alternatives to the traditional PV block. The first case report by Pfeiffer et al 10 of a landmark lamina technique was followed by a study in mastectomy patients 11 where this “blind” technique was used to inject local anesthetic between the thoracic laminae and the deep paraspinous muscles. This technique would logically decrease the chances of pleural injury, while the risk of inadvertent neuraxial injection remains.…”

Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy

“…Lack of expertise and safety concern in needling and local anesthetic dosing generally discourage the practice of nerve-blocking techniques in many hospitals in Nigeria. 4 , 20 The lamina approach with a needle entry point at 1.5 cm lateral to the T3 spinous process using contact with the vertebra lamina as an end-point of insertion was developed by Pfeiffer et al 7 Our technique was described as a safer, highly effective, and easy-to-adopt modification compared to the classic landmark approach. 1 The tunneling of the catheter into the paravertebral space engendered sufficient craniocaudal spread of LA, and our initial injection of 1% lidocaine with 1:200,000 epinephrine improved the onset time for surgery to begin 16 minutes after block completion, which is comparable with the incision time by Nikam et al 11 The appeal for lamina TPVB in settings such as ours is that a single injection of high LA volume with epinephrine to delay systemic absorption can reliably produce effective anesthesia and analgesia for mastectomies with axillary dissection.…”

“…Verbal contact was maintained throughout the block placement and surgery. With the patient sitting up on the operating table, a right-sided TPVB using Jüttner et al’s 1 modification of Pfeiffer et al’s 7 lamina technique was performed. The C7–T6 vertebral spinous processes were palpated and marked.…”

Analgesia in patients with or without single-shot lamina thoracic paravertebral block following breast cancer surgery in a Nigerian hospital

“…8,9 Each TPVB patient was placed in the sitting position on the operating table and C7-T6 vertebral spinous processes were palpated and marked. The scapular spine was palpated and identified as a landmark for T3 vertebral spinous process.…”