The role of paravertebral block in perioperative analgesia with focus on thoracic surgery
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1 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
2 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 nonfinancial relationships to disclose. Role of paravertebral block in perioperative analgesia, SARA 2015, 2
3 Role of paravertebral block in perioperative analgesia, SARA 2015, 3
4 Paravertebral block is great for perioperative analgesia and increases hospital cash Role of paravertebral block in perioperative analgesia, SARA 2015, 4
5 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, 5
6 Boezaart AP, Lucas SD, Elliott CE: Paravertebral block: cervical, thoracic, lumbar, and sacral. Curr Opin Anaesthesiol 2009, 22(5): Role of paravertebral block in perioperative analgesia, SARA 2015, 6
7 What is paravertebral block? Vogt A: Paravertebral block A new standard for perioperative analgesia. Trends in Anaesthesia and Critical Care 2013, 3(6): Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 7
8 pdf Role of paravertebral block in perioperative analgesia, SARA 2015, 8
9 Eason MJ, Wyatt R: Paravertebral thoracic block-a reappraisal. Anaesthesia 1979, 34(7): Role of paravertebral block in perioperative analgesia, SARA 2015, 9
10 PVB single shot, landmark method 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): Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 10
11 Technical developments and challenges Vogt A: Review about ultrasounds in paravertebral blocks. European Journal of Pain Supplements 2011, 5(S2): Role of paravertebral block in perioperative analgesia, SARA 2015, 11
12 Vogt A: Review about ultrasounds in paravertebral blocks. European Journal of Pain Supplements 2011, 5(S2): Role of paravertebral block in perioperative analgesia, SARA 2015, 12
13 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): Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 13
14 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): Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 14
15 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): Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 15
16 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): Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 16
17 Luyet C, Meyer C, Herrmann G, Hatch GM, Ross S, Eichenberger U: Placement of coiled catheters into the paravertebral space. Anaesthesia 2012, 67(3): Role of paravertebral block in perioperative analgesia, SARA 2015, 17
18 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): Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 18
19 Role of paravertebral block in perioperative analgesia, SARA 2015, 19
20 Role of paravertebral block in perioperative analgesia, SARA 2015, 20
21 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, andreas.vogt@insel.ch 21
22 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):e Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 22
23 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):e Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 23
24 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, 24
25 Role of paravertebral block in perioperative analgesia, SARA 2015, 25
26 Role of paravertebral block in perioperative analgesia, SARA 2015, 26
27 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): Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 27
28 Komatsu T, Sowa T, Takahashi K, Fujinaga T: Paravertebral Block as a Promising Analgesic Modality for Managing Post-Thoracotomy Pain. Ann Thorac Cardiovasc Surg Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 28
29 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 Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 29
30 Kaplowitz J, Papadakos PJ: Acute pain management for video-assisted thoracoscopic surgery: an update. J Cardiothorac Vasc Anesth 2012, 26(2): Role of paravertebral block in perioperative analgesia, SARA 2015, andreas.vogt@insel.ch 30
31 Summary statements & QA 1. Paravertebral block revival since 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 Role of paravertebral block in perioperative analgesia, SARA 2015, 31
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