David J Daly1, Paul S Myles. 1. Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Australia. dalyd@alfred.org.au
Abstract
PURPOSE OF REVIEW: To consider optimal analgesic strategies for thoracic surgical patients. RECENT FINDINGS: Recent studies have consistently suggested analgesic equivalence between paravertebral and thoracic epidural analgesia. Complications appear to be significantly less common with paravertebral analgesia. SUMMARY: There is good evidence that paravertebral block can provide acceptable pain relief compared with thoracic epidural analgesia for thoracotomy. Important side-effects such as hypotension, urinary retention, nausea, and vomiting appear to be less frequent with paravertebral block than with thoracic epidural analgesia. Paravertebral block is associated with better pulmonary function and fewer pulmonary complications than thoracic epidural analgesia. Importantly, contraindications to thoracic epidural analgesia do not preclude paravertebral block, which can also be safely performed in anesthetized patients without an apparent increased risk of neurological injury. The place of paravertebral block in video-assisted thoracoscopic surgery is less clear.
PURPOSE OF REVIEW: To consider optimal analgesic strategies for thoracic surgical patients. RECENT FINDINGS: Recent studies have consistently suggested analgesic equivalence between paravertebral and thoracic epidural analgesia. Complications appear to be significantly less common with paravertebral analgesia. SUMMARY: There is good evidence that paravertebral block can provide acceptable pain relief compared with thoracic epidural analgesia for thoracotomy. Important side-effects such as hypotension, urinary retention, nausea, and vomiting appear to be less frequent with paravertebral block than with thoracic epidural analgesia. Paravertebral block is associated with better pulmonary function and fewer pulmonary complications than thoracic epidural analgesia. Importantly, contraindications to thoracic epidural analgesia do not preclude paravertebral block, which can also be safely performed in anesthetized patients without an apparent increased risk of neurological injury. The place of paravertebral block in video-assisted thoracoscopic surgery is less clear.
Authors: Sean M Stokes; Elliot Wakeam; Mara B Antonoff; Leah M Backhus; Robert A Meguid; David Odell; Thomas K Varghese Journal: J Thorac Dis Date: 2019-03 Impact factor: 2.895
Authors: Iwona Zaporowska-Stachowiak; Aleksandra Kotlinska-Lemieszek; Grzegorz Kowalski; Katarzyna Kosicka; Karolina Hoffmann; Franciszek Główka; Jacek Luczak Journal: Onco Targets Ther Date: 2013-09-03 Impact factor: 4.147