Thoracic paravertebral block: a method of pain control

Gilbert, J.; Hultman, Jan

doi:10.1111/j.1399-6576.1989.tb02877.x

Cited by 49 publications

(18 citation statements)

References 15 publications

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“…It allows deep breathing, effective cough and compliance with chest physiotherapy. [1] Continuous thoracic paravertebral block (TPVB) produces sustained improvement in respiratory parameters and oxygenation[12] and is as effective as thoracic epidural analgesia[3] for providing pain relief in patients with unilateral MFR. It has low incidence of complications[4] and very few absolute contraindications.…”

Section: Introductionmentioning

confidence: 99%

Continuous paravertebral infusion of ropivacaine with or without fentanyl for pain relief in unilateral multiple fractured ribs

et al. 2013

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Background:Continuous thoracic paravertebral block (TPVB) provides effective analgesia for unilateral multiple fractured ribs (MFR). However, prolonged infusion of local anaesthetic (LA) in high doses can predispose to risk of LA toxicity, which may be reduced by using safer drugs or drug combinations. This study was conducted to assess efficacy and safety of paravertebral infusion of ropivacaine and adrenaline with or without fentanyl to provide analgesia to patients with unilateral MFR.Methods:Thirty adults, having ≥3 unilateral MFR, with no significant trauma outside chest wall, were studied. All received bolus of 0.5% ropivacaine 0.3 ml/kg through paravertebral catheter, followed by either 0.1-0.2 ml/kg/hr infusion of ropivacaine 0.375% with adrenaline 5 μg/ml in group RA or ropivacaine 0.2% with adrenaline 5 μg/ml and fentanyl 2 μg/ml in group RAF. Rescue analgesia was provided by IV morphine.Results:Statistical analysis was performed using unpaired Student t-test, Chi-square test and repeated measures ANOVA. After TPVB, VAS scores, respiratory rate and PEFR improved in both groups with no significant inter-group differences. Duration of ropivacaine infusion, morphine requirements, length of ICU and hospital stay, incidence of pulmonary complications and opioid-related side-effects were similar in both groups. Ropivacaine requirement was higher in group RA than group RAF. No patient showed signs of LA toxicity.Conclusion:Continuous paravertebral infusion of ropivacaine 0.375% with adrenaline 5 μg/ml at 0.1-0.2 ml/kg/hr provided effective and safe analgesia to patients with unilateral MFR. Addition of fentanyl 2 μg/ml allowed reduction of ropivacaine concentration to 0.2% without decreasing efficacy or increasing opioid-related side-effects.

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Section: Introductionmentioning

confidence: 99%

Continuous paravertebral infusion of ropivacaine with or without fentanyl for pain relief in unilateral multiple fractured ribs

et al. 2013

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“…[7] Of the various local and regional anaesthetic techniques evaluated in the past to reduce post-operative pain after breast surgery,[8–10] thoracic PVB appears promising due to reduction in post-operative pain, decreased opioid consumption with reduction in PONV, drowsiness, risk of respiratory depression and cost saving. [1112] Additional advantages reported include decrease in the incidence of chronic post-surgical pain and improvement in subcutaneous oxygenation in the wound site thus possibly reducing infection risk and improving wound healing. [13]…”

Section: Introductionmentioning

confidence: 99%

Post-operative pain and analgesic requirements after paravertebral block for mastectomy: A randomized controlled trial of different concentrations of bupivacaine and fentanyl

Bhuvaneswari

Mathew

et al. 2012

Indian J Anaesth

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Background:Paravertebral block (PVB) is useful for post-operative analgesia after breast surgery. Bupivacaine is used for PVB at higher concentrations (0.5%), which may lead to systemic toxicity after absorption. Therefore, we proposed to evaluate the efficacy of lower concentrations of bupivacaine with and without fentanyl for thoracic PVB in patients undergoing surgery for carcinoma breast.Methods:Forty-eight patients scheduled for surgery for breast cancer were enrolled in this prospective, randomized, double-blinded, placebo-controlled trial and were allocated to one of four groups: 0.25% bupivacaine with epinephrine 5 mcg/ ml, 0.25% bupivacaine + epinephrine 5 mcg/ ml with 2 mcg/ml fentanyl, 0.5% bupivacaine + epinephrine 5 mcg/ml or isotonic saline. PVB was performed and 0.3 ml/kg of the test drug was administered before induction of general anaesthesia. The primary outcome assessed was post-operative analgesic requirement for a period of 24 h. Secondary outcome measures were post-operative pain scores at rest and on movement of the arm, latency to first opioid, post-operative nausea and vomiting, quality of sleep, ability to move arm and patient satisfaction.Results:The patient characteristics and anaesthetic technique were comparable among the groups. The rescue analgesic consumption as well as cumulative pain scores at rest and on movement were significantly less in 0.25% bupivacaine+epinephrine with fentanyl and 0.5% bupivacaine+epinephrine groups (P<0.05). The average duration of analgesia was found to be 18 h after either 0.25% bupivacaine with epinephrine+fentanyl or 0.5% bupivacaine with epinephrine.Conclusions:Lower concentrations of bupivacaine can be combined with fentanyl to achieve analgesic efficacy similar to bupivacaine at higher concentrations, decreasing the risk of toxicity in PVB.

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“…After informed consent, a left-sided thoracic paravertebral block was performed at the level of the fifth of local anaesthetic alongside the thoracic vertebra, which thoracic spine using a 16-gauge Tuohy needle (Minipack, results in ipsilateral somatic and sympathetic nerve block, Portex, UK), according to the technique described by Eason spreading to levels above and below the site of injection. 1 and Wyatt, 10 and 3 cm of an epidural catheter were inserted Contralateral anaesthesia [2][3][4] adjacent to the site of injection into the paravertebral space. After negative aspiration of occurs in 1.1% of paravertebral injections.…”

mentioning

confidence: 99%

Thoracic paravertebral block: radiological evidence of contralateral spread anterior to the vertebral bodies

Karmakar

Kwok

Kew

2000

British Journal of Anaesthesia

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We report contralateral spread of contrast medium anterior to the vertebral bodies after injection of contrast through a thoracic paravertebral catheter that was used to manage pain in a patient with multiple fractured ribs. We review the literature and propose that the anatomical basis for this observation is spread in the extrapleural compartment of the thoracic paravertebral space along the subserous fascial plane.

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Thoracic paravertebral block: a method of pain control

Cited by 49 publications

References 15 publications

Continuous paravertebral infusion of ropivacaine with or without fentanyl for pain relief in unilateral multiple fractured ribs

Continuous paravertebral infusion of ropivacaine with or without fentanyl for pain relief in unilateral multiple fractured ribs

Post-operative pain and analgesic requirements after paravertebral block for mastectomy: A randomized controlled trial of different concentrations of bupivacaine and fentanyl

Thoracic paravertebral block: radiological evidence of contralateral spread anterior to the vertebral bodies

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