PARAVERTEBRAL BLOCK an underused block' - PowerPoint PPT Presentation

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PARAVERTEBRAL BLOCK an underused block'

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Paravertebral block: a simple block to achieve somatic and sympathetic neural ... pain in the intercostal area e.g. causalgia or neuralgia. ... – PowerPoint PPT presentation

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Title: PARAVERTEBRAL BLOCK an underused block'


1
PARAVERTEBRAL BLOCK- an underused block.
  • Dr Mahesh Shah
  • The General Infirmary at Leeds
  • U.K.

2
  • Paravertebral block a simple block to achieve
    somatic and sympathetic neural blockade of
    multiple dermatomes.

3
  • Clinical applications
  • Analgesia for- thoracic surgery
  • - upper abdominal surgery
    e.g. cholecystectomy
  • - breast surgery
  • - fractured ribs or
    contusions of the thoracic wall
  • - upper leg surgery
  • -

4
  • Clinical applications- posthoracotomy and
    postmastectomy pain
  • - acute herpes
    zoster
  • - pain in the
    intercostal area e.g. causalgia or neuralgia.

5
  • Anatomy of the thoracic paravertebral space
  • The paravertebral space is a wedge shaped
    compartment bounded by
  • Above and below heads and necks of the
    adjoining ribs
  • Posterior costo-tranverse ligaments
  • Medially communicates with the extradural space
    through the intevertebral
  • Laterally bound by the parietal pleura with the
    apex leading into the intercostals space
  • The base formed by the posterolateral aspect of
    the body of the vertebra and the intervertebral
    foramen
  • The upper aspect of the spinous process coincides
    with the transverse process of the lower vertebra

6
  • Technique of Thoracic paravertebral block.
  • The patient can be sitting, lateral or prone. The
    sitting position is the easiest. The needle is
    inserted 3cm lateral to the most cephalad portion
    of the spinous process and advanced at right
    angle to all skin planes to contact the
    transverse process of the vertebra below ( 2-4cm
    depth).
  • It is then redirected cephalad and advanced
    (1-1.5cm) till a loss of resistance is felt. A
    single injection of 15-20ml causes a blockade of
    4 to 5 dermatomes with a tendency to caudal
    spread.
  • Multiple injections can be performed.

7
  • Anatomy of Lumbar paravertebrals
  • Lumbar nerves exit the vertebral foramina
    inferior to the caudad edge of the transverse
    process. The anterior branches of L1 to L4 with a
    contribution from T12 form the lumbar plexus.
  • The cephalad aspect of the spinous process
    coincides with the caudad aspect of the
    homologous transverse process.

8
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10
  • Technique of Lumbar paravertebral block
  • The patient is placed prone or lateral. At a
    point 3cm lateral to the cephalad edge of the
    spinous process the needle is inserted at right
    angles in all planes till it contacts the caudad
    aspect of the homologous transverse process.
  • The needle is then redirected off the caudad edge
    till a loss of resistance is felt and an impulse
    obtained with a nerve stimulator or paraesthesia
    is felt.

11
  • Continuous catheter techniques can be used

12
Complications
  • Local anaesthetic toxicity
  • Pneumothorax lt1
  • Epidural diffusion 1
  • Hypotension lt5
  • Intravascular injection into the vena cava or
    aorta is possible.

13
Conclusion
  • The paravertebral block is an underused block
    with a low risk of complications.
  • It is easy to learn and use in clinical practice.
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