<p>Ultrasound-Guided Multilevel Thoracic Paravertebral Block and Its Efficacy for Surgical Anesthesia During Primary Breast Cancer Surgery</p>

Abstract

Purpose: Thoracic paravertebral block (TPVB), in conjunction with intravenous sedation, is reported to provide surgical anesthesia for primary breast cancer surgery (PBCS). Although ultrasound-guided (USG) TPVB has been described, there are no reports of USG multilevel TPVB for surgical anesthesia during PBCS. The aim of this prospective observational study was to determine the feasibility of performing USG multilevel TPVB, at the T1-T6 vertebral levels (6m-TPVB), and to evaluate its efficacy in providing surgical anesthesia for PBCS. Patients and Methods: Twenty-five female patients undergoing PBCS received an USG 6m-TPVB for surgical anesthesia. Four milliliters of ropivacaine 0.5% (with epinephrine 1:200,000) was injected at each vertebral level. Dexmedetomidine infusion (0.1-0.5 µg.kg −1 .h −1) was used for conscious sedation. Success of the block, for surgical anesthesia, was defined as being able to complete the PBCS without having to resort to rescue analgesia or convert to GA. Results: The USG 6m-TPVB was successfully performed on all 25 patients but it was effective as the sole anesthetic in only 20% (5/25) of patients. The remaining 80% (20/25) reported pain during separation of the breast from the pectoralis major muscle and its fascia. Surgery was successfully completed using small doses of intravenous ketamine (mean total dose, 38.0±20.5 mg) as supplementary analgesia. Conclusion: USG 6m-TPVB is technically feasible but does not consistently provide complete surgical anesthesia for PBCS that involves surgical dissection on the pectoralis major muscle and its fascia. Our data suggest that the pectoral nerves, which are not affected by a 6m-TPVB, are involved with afferent nociception.

Successful Percutaneous Nephrolithotomy Using Thoracic Paravertebral Block as the Sole Surgical Anesthesia: Cases Report

“…12,13 Therefore, multiple injections at more than one level are needed in TPVB for complete sensory blockade for surgical anesthesia. 9 In the present case report, we performed separate injections at three levels of the TPVS (T8, T10, T12) to ensure adequate spreading of the local anesthetic and complete sensory blockade from level T10 to level L2 for surgical anesthesia in PCNL. In addition, we injected about 7 ml of local anesthetic at each level for a total of 20 ml of 0.5% levobupivacaine.…”

“…Multilevel TPVB can be used as surgical anesthesia in major breast cancer surgery with conscious sedation. 9 However, there is limited information using TPVB as the sole anesthesia for the PCNL procedure. Renal pain sensation is transmitted through nerves originating from levels T10 to L1, while pain sensation from the ureter is transmitted to the spinal from T10 to L2.…”

“…An ultrasound pre-scan was done to optimize thoracic paravertebral space (TPVS) visualization using a low frequency (3-6 megahertz) curvilinear transducer (Figure 1B). To perform three injections of TPVB (3m-TPVB) at the articular processes 9 , the ultrasound transducer was initially placed for a paramedian transverse scan [2 centimeter (cm) lateral from the midline] to visualize the transverse process. After that, the ultrasound transducer was moved slightly caudally until the window of the transverse process is disappeared.…”

“…At that level the PVS has the widest visualization of space (Figure 1C). 9 The block procedure was done under sterile conditions and the ultrasound transducer was also covered with a sterile drape. 3m-TPVB at levels T8, T10, and T12 was performed under real-time ultrasound guidance starting from the T8 to the T10 and T12 levels.…”

Is It Useful and Necessary to Add a T2 Paravertebral Block to the Regional Anesthesia During Proximal Humeral Fracture Surgery in Elderly Patients? A Prospective and Randomized Controlled Trial

“…This slight discrepancy might be due to the sensibility of remifentanil in the elderly ( 30 ). As the method described by Pangthipampai et al ( 31 ), we also injected the LA into the apex of TPVS at the level of the transverse process, which is far from the intervertebral foramen. This will help to prevent unintentional epidural spread and neuraxial complications.…”