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Paravertebrals

Discussion in 'Anesthesiology' started by Idon'tknow??, Apr 30, 2007.

  1. Idon'tknow??

    Idon'tknow?? Member 10+ Year Member

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    Jul 17, 2001
    I was wondering if your program is performing paravertebral blocks? My program has a strong push from the top to perform these blocks, and the attending reaction is mixed. Any thoughts on paravertebrals?
     
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  3. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

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    Apr 22, 2007
    Southeast
    The studies on the efficacy of Paravertebral blocks are mixed. A few show very good pain relief for Thorascopic Surgery Patients while others show the benefit is 6-8 hours postoperatively.

    There are centers using this block for Mastectomy as well. Personally, the data is not convincing enough to justify the technique. That said, I have performed the technique for Mastectomy and Thoracoscopy. Still, I question the real added value of this block.

    Now, a Catheter at one or two levels may change my opinion. Again, not enough published data to make a good claim either way.

    Blade
     
  4. mille125

    mille125 7+ Year Member

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    Dec 8, 2006


    I think that they work well in mastectomy patients. However, you have to do a lot of blocks (all the way to T2) if axillary node dissection is involved. I have done them as the sole anesthetic in these cases and they work. A large percentage likely tracts epidurally.
     
  5. VolatileAgent

    VolatileAgent Livin' the dream 7+ Year Member

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    Jul 6, 2005
    we have developed a novel way to introduce a paravertebral catheter at our institution, and we use them for all variety of thoracic surgeries to traumas where indicated. they work phenomenally, if placed correctly, and you get preservation of the thoracolumbar sympathetic chain (ie., you are only blocking one side) so you pretty much don't see the hypotension associated with a thoracic epidural. these are placed pre and post-operatively, as well as in the units.
     
  6. pmichaelmd

    pmichaelmd Senior Member 10+ Year Member

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    Sep 14, 2003
    Georgia
    We use paravertebrals for breast surgeries and are able to cover for axillary dissection by covering T1-T6 with 2-3 cc 0.5% rop at each level. Seems to work very well and the surgeon can augment with some local infiltration in the field as needed. We also use stimulators to place lumbar PVBs for hernia surgeries and have had great results. Kinda cool to watch the dermatomes jump as we cover T10 - L1 :)

    Regards,
    PMMD
     
  7. Planktonmd

    Planktonmd Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    I think they are too much work for a private practice setting.
     

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