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First described by Hugo Selheim in 1906
Modified by Artur Lawen in 1911
Rapid development of general anaesthesia techniques
The resurgence of interest in thoratic paravertebral
block in the 90s
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Postoperative anaelgesia
• Thoracic surgery
• Breast surgery
• Cholecystectomy
• Herniorrhaphy
• Appendicectomy
A
di
t
S
Surgical
i l anaesthesia
th i
• Breast surgery
• Herniorrhaphy
• Chest wound exploration in a single transplant recipient
Acute postherpetic neuralgia
• Video-assisted thoracoscopic surgery
• Minimally invasive cardiac surgery
Chronic pain management: benign and malignant
neuralgia
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Mi
Miscellaneous
ll
Simplicity
• Fractured ribs
Low incidence of complications
• Therapeutic control of
h
hyperhydrosis
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i
Quality of pain relief after thoracic surgery with paravertebral block
(PVB) is comparable to that of epidural analgesia
• Liver capsule pain after blunt
abdominal trauma
Thoracic paravertebral block has minimal influence to the
haemodynamic function:
Hypotension and bradycardy
Systemic vascular resistance (SVR) and pulmonary vascular
resistance (PVR)
Pulmonary shunt (Qs/Qt)
PVB can be performed in deep sedation as well as in general
anaesthesia
Reduction of the intraoperative surgical stress response
Local anaesthetic toxicity
Pneumothorax
Epidural or spinal blockade
Coronary perfusion pressure (CPP)
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Intrapleural block
Hypotension
Vascular puncture
Pleural puncture 1.1%
1 1%
Pneumothorax 0.5%
Vascular puncture 3.8%
3 8%
Hypotension 4.6%
Lönnqvist PA, MacKenzie J, Soni AK i wsp. Paravertebral blockade: failure rate and complications. Anaesthesia
1995; 50: 813-815.
Thoracic paravertebral anaesthesia is a good
technique for postthoracotomy pain
management.
Thoracic paravertebral block has minimal
influence to the haemodynamic function. It
should be provided to patients with coexisting
cardiovascular diseases.
The technique colud be provided in patients
with coagulopathy, central nervous system
diseases or deformation of vertebral column.
Thoracic paravertebral block can be performed
in deep sedation as well as in general
anaesthesia.
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