Outcomes After Paravertebral Blocks

Abstract

Paravertebral block (PVB) was introduced by Hugo Sellheim almost a century ago for use in abdominal surgery in early 1919. 1 Eason and Wyatt 2 revived this technique in 1979. Although investigators used it extensively in Europe in patients admitted to the hospital, Wood et al 3 introduced it in the ambulatory setting for the first time in 1981. It is only since the report of Weltz et al 4 in 1995 on the management of breast cancer surgery as an ambulatory surgical procedure that the use of this technique was widely adopted for many ambulatory surgical procedures. Currently, a number of surgical procedures are facilitated with the use of PVBs either as a sole anesthetic or as an analgesic adjuvant. This chapter provides a review on the outcomes associated with the use of PVB. Current Applications of Paravertebral BlockPVBs can be placed in the cervical, 5,6 thoracic, and/or lumbar regions. The blocks can be performed as a single-injection technique or a continuous catheter technique and are used for a variety of surgical procedures both in the ambulatory setting and in the patients admitted to the hospital. The technique involves anesthetizing the intervertebral nerves as they emerge from the intervertebral foramina. 1 The cervical PVB is used as an alternate approach to the conventional interscalene brachial plexus block and is used mainly for shoulder surgery. 5,6 Historically, the lumbar PVB is considered synonymous with the posterior lumbar plexus block 7 that is used for lower limb surgery and to provide lower limb sympathetic, motor, and sensory block; however, the needle entry point for a lumbar PVB (as for hernia surgery from T 11 -L 2 ) is more cephalad and medial to the usual needle entry point at the level of L 4 for a lumbar plexus psoas compartment block used for lower extremity surgery. The thoracic PVB is used 185

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

“…The reported advantages of TPVB include a simplicity of technique, safety of performing in sedated and ventilated patients, lower amount of local anesthetic loss in intercostal drains as compared to intrapleural block, a low incidence of complications, facilitation of early mobilization, and early discharge. [ 2 11 ] The feasibility, efficacy, and safety of landmark-guided TPVB in on pump cardiac surgery was first studied by Canto et al . in 111 patients (47 after induction of anesthesia and 64 in awake sitting position).…”

Anesthesia management with single injection paravertebral block for aorta coarctation in infant

“…Therefore, inadequately‐treated postoperative pain compromises respiratory function and may result in adverse effects in children undergoing aortic coarctation repair. Numerous studies have demonstrated that, in adult patients, after thoracotomy, the most favorable outcomes were obtained when adequate analgesia was provided by paravertebral block . It is reported that paravertebral block procedure is technically easy to learn and as effective as epidural block .…”

“…Numerous studies have demonstrated that, in adult patients, after thoracotomy, the most favorable outcomes were obtained when adequate analgesia was provided by paravertebral block . It is reported that paravertebral block procedure is technically easy to learn and as effective as epidural block . It also improves patient's well‐being in terms of reduction in opioid use, postoperative nausea and vomiting, less urinary retention, improved hemodynamic changes, early discharge, prevention of pulmonary functions, and improvement in oxygenation and reduction in stress response .…”

Thoracic paravertebral block for implantable cardioverter-defibrillator and laser lead extraction

“…Paravertebral block is equianalgesic to a thoracic epidural for thoracotomy, according to Davies et al [13], with fewer complications such as urinary retention, PONV, or hypotension. Ganapathy et al [14] examined outcomes after PVBs and determined that, in breast surgery, PVBs resulted in decreased opioid use in the recovery room, lower frequency of PONV, and faster recovery from anesthesia. In patients who underwent thoracic surgery, pulmonary function was better preserved, there was a shorter hospital stay, and patient care costs were reduced when PVBs were used.…”