The role of paravertebral block in perioperative …...2015/06/06 · Eason MJ, Wyatt R:...

The role of paravertebral block in

perioperative analgesia with

focus on thoracic surgery

PD Dr. med. Andreas Vogt, Senior Consultant

Head of Anaesthesia for General, Thoracic and Liver Transplantation Surgery

University Department of Anaesthesiology and Pain Medicine

Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 2

Speaker PD Andreas Vogt

1. PD A. Vogt is employed by the University Hospital

Bern, Inselspital.

2. PD A. Vogt has no relevant financial or nonfinan-

cial relationships to disclose.

http://www.insel.ch/fileadmin/inselspital/users/ueber_das_Inselspital/Mediendienst/Bilder/Medien-Download/

Paravertebral block is

great for perioperative

analgesia and increases

hospital cash

http://www.haz.de/Hannover/Aus-der-Stadt/Uebersicht/MHH-Vize-Baumann-geht-nach-Bern

http://www.anaesthesiologie.insel.ch/de/ueber-uns/klinik-leitung

1) What is paravertebral block?

2) Technical developments & challenges?

3) Efficacy and safety?

4) Summary statements & QA?

Boezaart AP, Lucas SD, Elliott CE: Paravertebral block: cervical, thoracic, lumbar, and sacral. Curr Opin Anaesthesiol 2009, 22(5):637-643.

What is paravertebral block?

Vogt A: Paravertebral block – A new standard for perioperative analgesia. Trends in Anaesthesia and Critical Care 2013, 3(6):331-335.

http://de.wikipedia.org/wiki/Hugo_Sellheim

http://www.frca.co.uk/Documents/224%20Paravertebral%20block,%20Landmark%20techniques.

Eason MJ, Wyatt R: Paravertebral thoracic block-a reappraisal. Anaesthesia 1979, 34(7):638-642.

Vogt A, Stieger DS, Theurillat C, Curatolo M: Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic

surgery. Br J Anaesth 2005, 95(6):816-821.

PVB single shot, landmark method

Vogt A: Review about ultrasounds in paravertebral blocks. European Journal of Pain Supplements 2011, 5(S2):489-494.

Technical developments and challenges

Vogt A: Review about ultrasounds in paravertebral blocks. European Journal of Pain Supplements 2011, 5(S2):489-494.

Luyet C, Herrmann G, Ross S, Vogt A, Greif R, Moriggl B, Eichenberger U: Ultrasound-guided thoracic paravertebral puncture and placement of

catheters in human cadavers: where do catheters go? Br J Anaesth 2011, 106(2):246-254.

Abdallah FW, Brull R: Off side! A simple modification to the parasagittal in-plane approach for paravertebral block. Reg Anesth Pain Med 2014,

39(3):240-242.

Luyet C, Meyer C, Herrmann G, Hatch GM, Ross S, Eichenberger U: Placement of coiled catheters into the paravertebral space. Anaesthesia 2012,

67(3):250-255.

Efficacy and Safety?

Norum HM, Breivik H: A systematic review of comparative studies indicates that paravertebral block is neither superior nor safer than epidural

analgesia for pain after thoracotomy. Scandinavian Journal of Pain 2010, 1(1):12-23.

Norum HM, Breivik H: Published evidence from randomised trials indicates that pain after thoracotomy is more effectively relieved by thoracic

epidural analgesia than by paravertebral blocks. Eur J Anaesthesiol 2013, 30(5):261.

Ding X, Jin S, Niu X, Ren H, Fu S, Li Q: A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for

thoracotomy: an updated meta-analysis. PLoS One 2014, 9(5):e96233.

Ding X, Jin S, Niu X, Ren H, Fu S, Li Q: A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for

thoracotomy: an updated meta-analysis. PLoS One 2014, 9(5):e96233.

Maxwell C, Nicoara A: New developments in the treatment of acute pain after thoracic surgery. Curr Opin Anaesthesiol 2014, 27(1):6-11.

http://www.postoppain.org/frameset.htm

Yoshida T, Fujiwara T, Furutani K, Ohashi N, Baba H: Effects of ropivacaine concentration on the spread of sensory block produced by continuous

thoracic paravertebral block: a prospective, randomised, controlled, double-blind study. Anaesthesia 2014, 69(3):231-239.

Komatsu T, Sowa T, Takahashi K, Fujinaga T: Paravertebral Block as a Promising Analgesic Modality for Managing Post-Thoracotomy Pain.

Ann Thorac Cardiovasc Surg 2013.

Neuburger PJ, Ngai JY, Chacon MM, Luria B, Manrique-Espinel AM, Kline RP, Grossi EA, Loulmet DF: A Prospective Randomized Study of

Paravertebral Blockade in Patients Undergoing Robotic Mitral Valve Repair. J Cardiothorac Vasc Anesth 2015.

Kaplowitz J, Papadakos PJ: Acute pain management for video-assisted thoracoscopic surgery: an update. J Cardiothorac Vasc Anesth 2012, 26(2):312-

Summary statements & QA

1. Paravertebral block revival since 1979

2. Introduction of ultrasound guidance

3. Evidence of good efficacy for perioperative analgesia in

minimal invasive thoracic surgery

4. Side effects like hypotension, urinary retention, nausea

and block failure in favor of PVB compared with epidurals

5. Conflicting evidence for perioperative analgesia in open

thoracic surgery compared with epidurals

6. High analgesic efficacy for surgical placed continuous

7. Pig tail catheters might improve continuous PVB

technique

8. Same safety precautions like for epidurals are strongly

recommended

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