1 / 29

Paravertebral Block Unvisited territory

Karmakar M: Thoracic Paravertebral Block. Anesthesiology 2001;95:771-80.. Hugo Sellheim 1905. abdominal analgesiaKappis 1919. surgical anesthesiaEason

molimo
Download Presentation

Paravertebral Block Unvisited territory

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


    1. Paravertebral Block Unvisited territory Adil Kamal MD American Board Of Anesthesiology Consultant Anesthesiology & Pain Management, APS director Anesthesia Residency Program Director King Faisal Specialist Hospital & Research Center Riyadh- Saudi Arabia 3/27/2012 1

    2. Karmakar M: Thoracic Paravertebral Block. Anesthesiology 2001;95:771-80. Hugo Sellheim 1905. abdominal analgesia Kappis 1919. surgical anesthesia Eason & Wyatt 1979. revisited PVB, cont cath. 3/27/2012 2

    3. 3/27/2012 3

    4. 3/27/2012 4

    5. 3/27/2012 5

    6. 3/27/2012 6

    7. Indications Breast Surgery. - Bx ? MRM (T1-T6). - pt with chemotherapy induced CP disease. ( adriamycin cardiomyopathy, bleomycin pulmonary fibrosis). - Reduction mammoplasty.( ? Bilateral catheters). - breast augmentation.( ? bilateral catheters). 3/27/2012 7

    8. Coveney & colleagues. - 156 cases. - surgical anesthesia in 85 % with PVB,s alone, 91% with PVB,s & local anesthetic supp. - reduced incidence of PONV. - prolonged postoperative pain relief. - minimize narcotic use. Coveney E , Use of paravertebral block anesthesia in surgical management of breast cancer: experience in 156 cases. Ann Surg, 227(4) 1998.496-501. 3/27/2012 8

    9. Results PONV medications. Narcotic use. Discharge on D1. PVB,s GA 20 % 39 % 25 % 98 % 96 % 76 % 3/27/2012 9

    10. Postoperative analgesia for thoracic surgery & rib resection. - PVB catheter ( unilateral or bilateral)?. - according to level of incision.( T3 – T8). 3/27/2012 10

    11. Postoperative analgesia for open¹ or laparoscopic Cholecystectomy , Nephrectomy & appendectomy². - T6 – T 11. 3/27/2012 11

    12. Inguinal, Ventral & umbilical hernia. - unilateral or bilateral block may be needed. - T 11- L2 for inguinal hernia². -B T7-T11 for ventral or Umbilical hernia¹. 3/27/2012 12

    13. ICBG ( T11- L3). Minimally invasive Cardiac Surgery. - unilateral or bilateral catheters. - T1-T7. 3/27/2012 13

    14. Rib Fracture ( block Vs catheter ?). Colostomy/ Iliostomy closure. Post Herpetic Neuralgia. Other chronic somatic malignant or non-malignant pain syndromes ( CRPS). - block Vs catheter. 3/27/2012 14

    15. Labor analgesia ( B T11)? analgesia for 1st stage of labor. Post operative analgesia for CS. -B T10- T12 Inguinal LN dissection ( T12- L2). Axillary dissection ( T1-T3). 3/27/2012 15

    16. 3/27/2012 16

    17. Technique Monitors. Resuscitation. O2. Sedation. position 3/27/2012 17

    18. 3/27/2012 18

    19. 3/27/2012 19

    20. 3/27/2012 20

    21. 3/27/2012 21

    22. 3/27/2012 22

    23. 3/27/2012 23

    24. Mechanism of spread 15 cc ? 5 dermatomes (1-9) & 8 sympathetic ( 6-10). Preferential caudal spread. Contra lateral sympathetic blockade without sensory blockade ( B Horner's). Epidural spread in 70%. Contra lateral anesthesia. 3/27/2012 24

    25. 3/27/2012 25

    26. Absolute contraindications Pt refusal. Allergy to local anesthesia. Empyema. Infection at the site.( active herpes at the site). Tumor occupying PV space. 3/27/2012 26

    27. Relative Contraindications Coagulopathy. Therapeutic anticoagulation. - catheter may be appropriate? outside the central neuroaxis. Kyphoscoliosis. Previous thoracotomy ( adhesions). 3/27/2012 27

    28. Complications Failure rate 7-10 %. Infection. Bleeding. Intravascular injection / puncture (3.8%). Nerve injury. Epidural spread? hypotension ( 4.6%). 3/27/2012 28

    29. Spinal injection? High spinal, PDPH. Spread to the opposite side. Horner's syndrome. Pleural puncture (1.1 %). Pneumothorax (conservative management). Ipsilateral ulnar nerve blockade( T1). 3/27/2012 29

    30. 3/27/2012 30

More Related