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Paravertebral-peridural block technique: a unilateral thoracic block.
1Pain Control Center, Presbyterian-University Hospital, Pittsburgh, Pennsylvania.
The Clinical Journal of Pain
|September 1, 1990
Summary
The paravertebral-peridural block offers a safe and effective method for unilateral thoracic anesthesia across multiple dermatomes. This technique provides reliable pain relief with a low complication rate, benefiting patients with acute and chronic pain.
Area of Science:
- Anesthesiology
- Pain Management
- Thoracic Surgery
Background:
- Achieving unilateral anesthesia in multiple thoracic dermatomes is crucial for pain management.
- The multidermatomal intercostal technique's mechanism is debated.
- A modified paravertebral block, termed paravertebral-peridural block, has been utilized for over two decades.
Purpose of the Study:
- To evaluate the safety and efficacy of the paravertebral-peridural block for unilateral anesthesia.
- To clarify the anatomical mechanism behind potential bilateral blockade from this unilateral technique.
Main Methods:
- Retrospective analysis of 384 paravertebral-peridural blocks performed between 1982 and 1986.
- Cadaveric injection study using colored latex to visualize spread after paravertebral-peridural approach.
Main Results:
- Low complication rates: 0.26% pneumothorax, 0.26% thecal puncture, 0.52% intrathecal injection, 4.6% transient hypotension.
- 93% of blocks were rated "good" or "excellent".
- Cadaver study revealed prevertebral midline spread to the contralateral paravertebral space, explaining bilateral blockade.
Conclusions:
- The paravertebral-peridural thoracic block is a reliable and safe technique.
- It effectively achieves unilateral anesthesia over multiple dermatomes with a single injection.
- Understanding the anatomical spread clarifies the mechanism of action.
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