Comparison of the Hemodynamic Effects of a Single 5 mg/kg Dose of Lidocaine With or Without Epinephrine for Thoracic Paravertebral Block

Abstract

Addition of epinephrine to lidocaine when performing thoracic paravertebral block, attenuates the cardiodepressive effects associated with the systemic absorption of lidocaine and also, as a result of the beta-adrenergic consequences of epinephrine, systemic absorption from the paravertebral space.

A combination of levobupivacaine and lidocaine for paravertebral block in breast cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations than levobupivacaine alone

“…Other trials also showed a significant decrease in MAP values between 30 and 45 minutes from block administration ( 3 , 30 ). Garutti et al ( 30 ) explained the hypotension as due to the prompt resorption and vasodilating effect of lidocaine and the unrecognized hypovolemic state of the patient. Our trial confirmed the results published by previous studies regarding the hemodynamic changes, namely the increase in SVV, decrease in MAP and CO, and minimal changes in HR ( 30 , 31 ).…”

“…The reason was that we wanted to be certain that the block was successful before using minimally invasive hemodynamic monitoring. To increase measurement precision, the measurement intervals were set at 5 minutes during the first hour, while in other studies, measurements were set at 15-minute intervals during the first hour ( 3 , 30 ). Other trials also showed a significant decrease in MAP values between 30 and 45 minutes from block administration ( 3 , 30 ).…”

“…To increase measurement precision, the measurement intervals were set at 5 minutes during the first hour, while in other studies, measurements were set at 15-minute intervals during the first hour ( 3 , 30 ). Other trials also showed a significant decrease in MAP values between 30 and 45 minutes from block administration ( 3 , 30 ). Garutti et al ( 30 ) explained the hypotension as due to the prompt resorption and vasodilating effect of lidocaine and the unrecognized hypovolemic state of the patient.…”

“…Garutti et al ( 30 ) explained the hypotension as due to the prompt resorption and vasodilating effect of lidocaine and the unrecognized hypovolemic state of the patient. Our trial confirmed the results published by previous studies regarding the hemodynamic changes, namely the increase in SVV, decrease in MAP and CO, and minimal changes in HR ( 30 , 31 ). Casati et al ( 32 ) attributed such changes to the effect of PVB on the peripheral and unilateral nerve blockade with resulting local vasodilation and a minor sympathetic block.…”

Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression

“…Two small trials (with a total of 20 patients in the PVB groups between them) were published in French. 1 80 One trial 38 investigated specifically the haemodynamics of PVB and reported no data on pain or pulmonary function (Fig. 1).…”