Gasbag Anaesthesia Forums

hi,
  i want to know from all of you regarding utility of thoracic paravertebral block.i have given few paravertebral blocks all in case of mastectomies.when i compared it with thoracic epidural block,i found paravertebral thoracic block superior to thoracic epidural block.i found wonderful painfree period after giving paravertebral block.rescue analgesics after 12 hours.if you put catheter then there is no question of rescue analgesics.no pulmonary complications in each cases.i think it can be used where thoracic epidural block is contraindicated like hypovolemia etc
                                                                        DR.SIMANT

i am sorry for my intervention.regarding pulmonary complications  i want to talk just exclude pneumothorax in a case of paravertebral block as its totally iatrogenic.thank you all.

Dr Simant;
I have beeen using thorasic paravertebral blocks for quit some time for uni/bilateral mastectomies, and out-patient breast augmentation.  I use 0.5% ropivacaine and add my own epi.  I have found that this gives excelent post analgesia for 12-18 hours.  I place the block pre-operatively with some sedation.  The paients all are very pleased.  I have had only one complication where I used aTPVB for a breast augmentation and three days later the patient developed a hemothorax on one side.  A chest tube relieved the problem and no futher sequalie developed.  I have to say the this perticular patient was 24yo. 4'10" and weighed only 90 lbs...ie more like a pediatric patient then an adult which probably contributed to the complication. So FYI just be aware that complications can and do occur.  I have done several thousand of these blocks and this was the only complication.  I still give the patients a general anesthesia after the block but need only enough to tolorate the ET-tube.  There is an excelent article from Duke University where they use TPVB for mastectomies on an out-patient basis.( can't remember peridocial or year and month of article..sorry it was 4-5 years ago)  Since I have stared using TPVB I haven't used a thorasic epidural for any of my thorasic cases.  This is also a useful block for laprascopic cholecyctectomies that turn into open cholecyctectomies.