Paravertebrals

[Idon'tknow??]

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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[BLADEMDA]

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?

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

 

[mille125]

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

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.

 

[VolatileAgent]

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.

 

[pmichaelmd]

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

 

[Planktonmd]

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