Serbülent Gökhan BEYAZ, Tolga ERGÖNENÇ, Fatih ALTINTOPRAK, Ali Fuat ERDEM

Meme cerrahisi için torakal paravertebral blok

Torakal paravertebral blok (TPVB), dengeli hemodinamik yanıtla seyreden güvenli bir anestezi sağlaması, kateter aracılığıyla postoperatif ağrı kontrolüne imkân vermesi ve düşük yan etki profili nedeniyle genel anesteziye alternatif bir yöntemdir. Meme kanser cerahisi geçiren olgularda da aynı nedenle güvenle uygulanabilir bir yöntem olan TPVB çok az merkezde genel anestezi yerine uygulanmaktadır. Meme cerrahisi altında hastalar için yeterli bir anestezi sağlamasının yanında, unilateral somatik ve sempatik blokaj ile stabil bir hemodinamik denge, mükemmele yakın postoperatif ağrı kontrolü, minimal bulantı-kusma oranı, erken taburculuk ve düşük maliyet sağlar. Bu nedenle bazı merkezlerde meme cerrahileri için standart bir yöntem olan torakal paravertebral blok tüm anestezistler tarafından bilinmelidir. Torakal paravertebral bloğun genel anestezinin yerine uygulanacak bir yöntem olduğu kanaatindeyiz.

Anahtar Kelimeler:

Paravertebral blok, torakal, meme cerrahisi, rejyonel anestezi

Thoracal paravertebral block for breast surgery

Thoracic paravertebral block (TPVB) is an alternative method to general anesthesia because of provides a safe anesthesia with balanced hemodynamic response, allows postoperative pain control by means of catheter and has low side effect profile. TPVB performed safely for the patients undergoing breast cancer surgery with the same reason, has used in too few center instead of general anesthesia. This technique provides an adequate anesthesia for the patients undergoing breast surgery and in addition provides stable hemodynamic status with unilateral somatic and sympathetic blockade, near-perfect control of postoperative pain, minimal nausea and vomiting rate, early discharge and low cost. For this reason, thoracic paravertebral block which is a standard method in breast surgeries for some centers should be known by all anesthesiologists. We believe that, thoracic paravertebral block is a method can be applied instead of general anesthesia.

Keywords:

Paravertebral block, thoracic, breast surgery, regional anesthesia,

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Coveney E, Weltz CR, Greengrass R et al. Use of paraverte- bral block anesthesia in the surgical management of breast cancer: experience in 156 cases. Ann Surg 1998;227(4):496- 501.
Hala E.A. Eid. Paravertebral block: An overview. Current Anaesthesia & Critical Care 2009;20(1):65-70.
Eason MJ. Wyatt R. Paravertebral thoracic block-a reapprais- al. Anaesthesia 1979;34(5):638-42.
Richardson J, Lönnqvist PA. Thoracic paravertebral block. Br J Anaest 1998; 81(2): 230-8.
Richardson J, Lönnqvist PA, Naja Z. Bilateral thoracic paravertebral block: potential and practice. Br J Anaesth 2011;106(2):64-71.
Poleshuck EL, Katz J, Andrus CH et al. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain 2006;7(9):626-34.
Cheema SP, Ilsley D, Richardson J, et al. A thermo- graphic study of paravertebral analgesia. Anaesthesia 1995;50(1):118-21.
Yeğin A, Erdoğan A, Hadimoğlu N. Postoperative analge- sia for thoracic surgery. Turkish J Thorac Cardiovasc Surg 2005;13(4):418-25
Greengrass RA, Duclas R Jr. Paravertebral blocks. Int Anes- thesiol Clin. 2012;50(1):56-73.
Park S, Kim Y, Han K, et al. Thoracic paravertebral block for breast surgery in a pregnant woman. Korean J Anesthe- siol 2010; 59(Suppl):73-6
Karmakar MK. Thoracic paravertebral block. Anesthesiol- ogy 2001;95:771-80.
Tighe SQM, Greene MD, Rajadurai N. Paravertebral block. Continuing Education in Anaesthesia. Critical Care & Pain 2010;10(5):133-7.
Conacher ID, Kokri M. Postoperative paravertebral blocks for thoracic surgery. A radiological appraisal. Br J Anaesth 1987;59(2):155-61.
Naja MZ, Ziade MF, El Rajab M, et al. Varying anatomical injection points within the thoracic paravertebral space: ef- fect on spread of solution and nerve blockade. Anaesthesia 2004;59(4):459-63.
Richarson J, Jones J, Atkinson R. The effect of thoracic paravertebral blockade on intercostal somatosensory evoked potentials. Anesth Analg 1998;87(3):373-6.
Kirvela O, Antila H. Thoracic paravertebral block in chron- ic postoperative pain. Reg Anesth 1992;17(3):348-50
Tenicela R, Pollan SB. Paravertebral-peridural block tech- nique: a unilateral thoracic block. Clin J Pain 1990;6(3):227- 34.
Lönnqvist PA, MacKenzie J, Soni AK, et al. Paraverte- bral blockade. Failure rate and complications. Anaesthesia 1995;50(9):813-5.
Richardson J, Sabanathan S. Thoracic paravertebral analge- sia. Acta Anaesthesiol Scand 1995;39(8):1005-15.
Lall NG, Sharma SR. “Clicking” pneumothorax follow- ing thoracic paravertebral block. Case report. Br J Anaesth 1971;43(4):415-7.
Fagenholz PJ, Bowler GM, Carnochan FM, et al. Systemic local anaesthetic toxicity from continuous thoracic paraver- tebral block. Br J Anaesth 2012. doi:10.1093/bja/aes126
Calenda E, Baste JM, Danielou E, et al. Temporary quad- riplegia following continuous thoracic paravertebral block. J Clin Anesth 2012;24(3):227-30.
Lin HM, Chelly JE. Post-dural headache associated with tho- racic paravertebral blocks. J Clin Anesth 2006;18(5):376-8.
Buckenmaier 3rd CC, Steele SM, Nielsen KC, et al. Para- vertebral somatic nerve blocks for breast surgery in a pa- tient with hypertrophic obstructive cardiomyopathy. Can J Anaesth 2002;49(5):571-4.
Karmakar MK, Booker PD, Franks R, et al. Continuous extrapleural paravertebral infusion of bupivacaine for post-thoracotomy analgesia in young infants. Br J Anaesth 1996;76(6):811-5.
Purcell-Jones G, Pither CE, Justins DM. Paravertebral so- matic nerve block: A clinical, radiographic, and computed tomographic study in chronic pain patients. Anesth Analg 1989;68(1):32-9.
Karmakar MK, Kwok WH, Kew J. Thoracic paravertebral block: Radiological evidence of contralateral spread ante- rior to the vertebral bodies. Br J Anaesth 2000;84(2):263-5.
Lönnquist PA, Hesser U. Radiological and clinical distribu- tion of thoracic paravertebral blockade in infant and chil- dren. Pae-diatric Anaesth 1993;3(1):83-7.
Naja Z, Lönnquist PA. Somatic paravertebral nerve block- ade: Incidence of failed block and complications. Anesthe- sia 2001;56(9):1184-8.
Cooter RD, Rudkin GE, Gardiner SE. Day case breast augmentation under paravertebral blockade: a prospective study of 100 consecutive patients. Aesthetic Plast Surg 2007;31(6):666-73.
Karmakar MK, Gin T, Ho AM. Ipsilateral thoraco-lumbar anaesthesia and paravertebral spread after low thoracic paravertebral injection. Br J Anaesth 2001;87(2):312-6.
Thavaneswaran P, Rudkin GE, Cooter RD, et al. Brief re- ports: Paravertebral block for anesthesia: A systematic re- view. Anesth Analg 2010;110(6): 1740-4.
Hirsch J. Impact of postoperative nausea and vomiting in the surgical setting. Anaesthesia 1994; 49 (Suppl):30-3.
Singhal AK, Kannan S, Gota VS. 5HT3 antagonists for prophylaxis of postoperative nausea and vomiting in breast surgery: a meta-analysis. J Postgrad Med 2012;58(1):23- 31.
Cohen MM, Duncan PG, DeBoer DP, et al. The postopera- tive interview: Assessing risk factors for nausea and vomit- ing. Anesth Analg 1994;78(1):7-16.
Miguel R, Rothschiller J, Majchrzak J. Breast surgery is a high risk procedure for development of nausea and vomit- ing. An-esthesiology 1993;79(9):1095-9.
Greengrass R, O’Brien F, Lyerly K, et al. Paravertebral block for breast cancer surgery. Can J Anaesth 1996;43(8):858- 61.
Das S, Bhattacharya P, Mandal MC, et al. Multiple-injec- tion thoracic paravertebral block as an alternative to general anaesthesia for elective breast surgeries: A randomised con- trolled trial. Indian J Anaesth 2012;56(1):27-33.
Bhuvaneswari V, Wig J, Mathew PJ, et al. Post-operative pain and analgesic requirements after paravertebral block for mas-tectomy: A randomized controlled trial of different concentrations of bupivacaine and fentanyl. Indian J An- aesth 2012;56(1):34-9.
Li NL, Yu BL, Tseng SC, et al. The effect of improvoment of recovery and pain scores of paravertebral block imme- diately before breast surgery. Acta Anaesthesiol Taiwan 2011;49(3):91-5.
Pusch F, Freitag H, Weinstabl C, et al. Single-injection para- vertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand 1999;43(7):770-4.
Klein SM, Bergh A, Steele SM, et al. Thoracic paravertebral block for breast surgery. Anesth Analg 2000;90(6):1402-5.
Exadaktylos AK, Buggy DJ, Moriarty DC, et al. Can anes- thetic technique for primary breast cancer surgery affect re- currence or metastasis? Anesthesiology 2006;105(4):660-4.
Muñoz M, Rosso M, Casinello F, et al. Paravertebral an- esthesia: how substance P and the NK-1 receptor could be involved in regional block and breast cancer recurrence. Breast Cancer Res Treat 2010;122(2):601-3.
Oğuz S, Küçük C, Eskiçirak E, et al. Thoracic paravertebral block or breast surgery in a patient with myasthenia gravis. J Anesth 2007;21(3):449-50.
Stamatiou G, Athanasiou E, Simeoforidou M, et al. Tho- racic paravertebral block for breast surgery. Anaesthesia. 2004;59(7):723-4.
Bondár A, Szucs S, Iohom G. Thoracic paravertebral block- ade. Med Ultrason 2010;12(3):223-7.
O Riain SC, Donnell BO, Cuffe T, et al. Thoracic paraver- tebral block using real-time ultrasound guidance. Anesth Analg 2010;110(1):248-51.
Luyet C, Eichenberger U, Greif R, et al. Ultrasound-guided paravertebral puncture and placement of catheters in human ca-davers: an imaging study. Br J Anaesth 2009;102(4):534- 9.
Ben-Ari A, Moreno M, Chelly JE, et al. Ultrasound-guided paravertebral block using an intercostal approach. Anesth Analg 2009;109(5):1691-4.
Miguel R, Kuhn AM, Shons AR, et al. The effect of senti- nel node selective axillary lymphadenectomy on the inci- dence of postmastectomy pain syndrome. Cancer Control 2001;8(5):427-30.
Wallace AM, Wallace MS. Postmastectomy and post- thoracoto- my pain. Anesthesiol Clin North America 1997;15(2):353-370.
Kwekkeboom K. Postmastectomy pain syndromes. Cancer Nurs 1996;19(1):37-43.
Beyaz SG, Bayar F, Erdem AF. Acute postoperative pain. J Anesthe Clinic Res 2011;12(7):634-9.
Kairaluoma PM, Bachmann MS, Korpinen AK, et al. Preincisional paravertebral block reduces the preva- lence of chronic pain after breast surgery. Anesth Analg 2006;103(6):703-8.
Naccache N, Jabbour H, Nasser-Ayoub E, et al. Regional an- algesia and breast cancer surgery. J Med Liban 2009;57(2): 110-4.
Tahiri Y, Tran de QH, Bouteaud J et al. General anaes- thesia versus thoracic paravertebral block for breast sur- gery: a meta-analysis. J Plast Reconstr Aesthet Surg. 2011;64(10):1261-9.
Shnabel A, Reichl SU, Kranke P, et al. Efficacy and safety of paravertebral blocks in breast surgery: a meta- analysis of ran-domized controlled trials. Br J Anaesth 2010;105(6):842-52.