The role of paravertebral block in perioperative …...2015/06/06 · Eason MJ, Wyatt R:...
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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
Transcript of 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, [email protected] 2
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 3
University Department of Anaesthesiology and Pain Medicine
http://www.insel.ch/fileadmin/inselspital/users/ueber_das_Inselspital/Mediendienst/Bilder/Medien-Download/
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 4
University Department of Anaesthesiology and Pain Medicine
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
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University Department of Anaesthesiology and Pain Medicine
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?
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 6
University Department of Anaesthesiology and Pain Medicine
Boezaart AP, Lucas SD, Elliott CE: Paravertebral block: cervical, thoracic, lumbar, and sacral. Curr Opin Anaesthesiol 2009, 22(5):637-643.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 7
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 8
University Department of Anaesthesiology and Pain Medicine
http://de.wikipedia.org/wiki/Hugo_Sellheim
http://www.frca.co.uk/Documents/224%20Paravertebral%20block,%20Landmark%20techniques.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 9
University Department of Anaesthesiology and Pain Medicine
Eason MJ, Wyatt R: Paravertebral thoracic block-a reappraisal. Anaesthesia 1979, 34(7):638-642.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 10
University Department of Anaesthesiology and Pain Medicine
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
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 11
University Department of Anaesthesiology and Pain Medicine
Vogt A: Review about ultrasounds in paravertebral blocks. European Journal of Pain Supplements 2011, 5(S2):489-494.
Technical developments and challenges
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 12
University Department of Anaesthesiology and Pain Medicine
Vogt A: Review about ultrasounds in paravertebral blocks. European Journal of Pain Supplements 2011, 5(S2):489-494.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 13
University Department of Anaesthesiology and Pain Medicine
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.
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University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 15
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 16
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 17
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 18
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 19
University Department of Anaesthesiology and Pain Medicine
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 20
University Department of Anaesthesiology and Pain Medicine
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 21
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 22
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 23
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 24
University Department of Anaesthesiology and Pain Medicine
Maxwell C, Nicoara A: New developments in the treatment of acute pain after thoracic surgery. Curr Opin Anaesthesiol 2014, 27(1):6-11.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 25
University Department of Anaesthesiology and Pain Medicine
http://www.postoppain.org/frameset.htm
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 26
University Department of Anaesthesiology and Pain Medicine
http://www.postoppain.org/frameset.htm
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 27
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 28
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 29
University Department of Anaesthesiology and Pain Medicine
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.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 30
University Department of Anaesthesiology and Pain Medicine
Kaplowitz J, Papadakos PJ: Acute pain management for video-assisted thoracoscopic surgery: an update. J Cardiothorac Vasc Anesth 2012, 26(2):312-
321.
Role of paravertebral block in perioperative analgesia, SARA 2015, [email protected] 31
University Department of Anaesthesiology and Pain Medicine
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
PVB
7. Pig tail catheters might improve continuous PVB
technique
8. Same safety precautions like for epidurals are strongly
recommended
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