Safety of the paravertebral block in patients ineligible for epidural block undergoing pulmonary resection

• Published in: General thoracic and cardiovascular surgery 2012-12, Vol.60 (12), p.811-814
• Main Authors: Katayama, Tatsuya, Hirai, Shinji, Kobayashi, Rei, Hamaishi, Makoto, Okada, Takeshi, Mitsui, Norimasa
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amides - administration & dosage; Analgesia, Patient-Controlled - methods; Analgesics; Anesthesia; Anesthesia, Epidural; Anesthetics, Local - administration & dosage; Cancer therapies; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Catheters; Contraindications; Epidural; Female; Fentanyl; Hospitals; Humans; Hypertension; Hypotension; Lung cancer; Lung Neoplasms - surgery; Male; Medical personnel; Medicine; Medicine & Public Health; Middle Aged; Nerve Block - adverse effects; Nerve Block - methods; Original Article; Ostomy; Pain; Pain, Postoperative - etiology; Pain, Postoperative - therapy; Patients; Pneumonectomy; Pneumothorax; Respiratory failure; Surgical Oncology; Thoracic Surgery; Ventilation
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-012-0149-5

Objective We previously reported the noninferiority of paravertebral block (PVB) to epidural block. In this study, we assessed whether PVB via an intrathoracic approach was also safe for the patients ineligible for epidural block because of, for example, anticoagulation or antiplatelet therapy. Methods Patients admitted to our hospital for pulmonary resection between April 2010 and March 2012, and who were ineligible for epidural block for various reasons, were enrolled in this study. A catheter for PVB was inserted in the operative field by the surgeons just before closing the chest. Ropivacaine of 0.2 % was injected at 4 ml/h using an infuser pump for 5 days. Concurrent use of intravenous patient controlled analgesia (IVPCA) for 2 days with PVB was permitted as a post-operative analgesic at the discretion of anesthesiologists. We estimated the post-operative complications in these patients. Results A total of 35 (15.8 %) consecutive patients were enrolled in this study and successfully completed the study protocol. Thirty-two patients received concurrent IVPCA treatment. Post-operative complications due to PVB were not observed, but other complications included 1 incidence of atrial fibrillation, 1 hypertension, 1 pleural fluid accumulation, 1 respiratory failure requiring mechanical ventilation, and 1 of late chest pain requiring intercostal nerve block. Conclusion This study suggests that PVB is safe in patients ineligible for epidural block and can contribute to their pain relief following pulmonary resection procedure including video-assisted thoracic surgery.