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Thoracic Paravertebral Block For Breast Surgery

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https://www.readbyqxmd.com/read/30085935/ultrasound-guided-midpoint-transverse-process-to-pleura-block-in-breast-cancer-surgery-a-case-report
#1
Debesh Bhoi, Purnima Narasimhan, Ranjitha Nethaji, Praveen Talawar
To avoid the safety issues related to thoracic paravertebral blocks, we performed midpoint transverse process to pleura blocks in 3 patients before general anesthesia for modified radical mastectomies. The midpoint transverse process to pleura blocks served as the major component of multimodal analgesia. With ultrasound guidance, 7 mL of a mixture of 0.75% ropivacaine and 2% lidocaine with epinephrine were deposited at T2, T4, and T6 levels. We noted decreased sensation to cold and pinprick from T2 to T8 dermatome level with sparing of axilla and infraclavicular areas...
August 6, 2018: A&A practice
https://www.readbyqxmd.com/read/30027066/effect-of-dexmedetomidine-versus-nalbuphine-as-an-adjuvant-on-paravertebral-block-to-manage-postoperative-pain-after-mastectomies
#2
Mohammad Omar Mostafa, Joseph Makram Botros, Atef Mohammad Sayed Khaleel
Background and Objective: Breast cancer is the commonest cancer in women worldwide. Many patients are frequently admitted to the operating theaters for mastectomies. Thoracic paravertebral block (PVB) is increasingly used as an effective means for post-operative pain relief. The present study aimed at evaluating the effectiveness and safety of dexmedetomidine and nalbuphine as an adjuvant to bupivacaine local anesthetic in thoracic paravertebral block in breast cancer surgeries. Methods: A total of 60 female patients aged 18 to 78 were included in the study, and ASA I, II, III were scheduled for mastectomy...
April 2018: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/30012909/analgesic-effect-of-double-level-retrolaminar-paravertebral-block-for-breast-cancer-surgery-in-the-early-postoperative-period-a-placebo-controlled-randomized-clinical-trial
#3
Eiko Onishi, Mamoru Murakami, Ryo Nishino, Ruri Ohba, Masanori Yamauchi
Thoracic epidural anesthesia (TEA) and paravertebral block (PVB) have been performed for perioperative regional anesthesia in the trunk. However, TEA and PVB are associated with a risk of serious complications, such as pneumothorax, hypotension, or nerve damage. Retrolaminar paravertebral block (RLB) was introduced as a new alternative to PVB. This new approach might lower the risk of serious complications, but its use has not been well established yet. Therefore, we conducted a double-masked, placebo-controlled, randomized clinical trial to evaluate the efficacy of a double-level RLB for postoperative analgesia after breast cancer surgery...
July 2018: Tohoku Journal of Experimental Medicine
https://www.readbyqxmd.com/read/29983183/-ultrasound-guided-thoracic-paravertebral-block-for-closed-loop-ileostomy-repair-in-severe-copd-a-case-report
#4
Rocco D'Andrea, Guido Gambetti, Lorenzo Querci, Beatrice Amodei, Amedeo Bianchini
BACKGROUND AND OBJECTIVES: Ultrasound-guided thoracic paravertebral block is usually considered a good alternative to epidural thoracic for anesthesia and pain control in thoracic and breast surgery. Furthermore it has also been used during abdominal surgery lately, especially hepatic and renal surgery. However, its role is poorly defined in this context. The purpose of this report was to highlight the role of thoracic paravertebral block in providing effective anesthesia and analgesia during both the abdominal surgical intervention and pain control in post-operative period, avoiding possible complications which general anesthesia may arise, which are fairly common in patients with chronic obstructive pulmonary disease and similar comorbidities...
July 5, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29794879/should-thoracic-paravertebral-blocks-be-used-to-prevent-chronic-postsurgical-pain-after-breast-cancer-surgery-a-systematic-analysis-of-evidence-in-light-of-immpact-recommendations
#5
Nasir Hussain, Uma Shastri, Colin J L McCartney, Ian Gilron, Roger B Fillingim, Hance Clarke, Joel Katz, Peter Juni, Andreas Laupacis, Duminda Wijeysundera, Faraj W Abdallah
The role of thoracic paravertebral block (PVB) in preventing chronic postsurgical pain (CPSP) after breast cancer surgery (BCS) has gained interest, but existing evidence is conflicting, and its methodological quality is unclear. This meta-analysis evaluates efficacy of PVB, compared with Control group, in preventing CPSP after BCS, in light of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations. Electronic databases were searched for randomized trials comparing PVB with Control group for CPSP prevention after BCS...
May 23, 2018: Pain
https://www.readbyqxmd.com/read/29714650/real-time-view-of-anesthetic-solution-spread-during-an-ultrasound-guided-thoracic-paravertebral-block
#6
Domenico P Santonastaso, Annabella de Chiara, Marco Rispoli, Giovanni Musetti, Vanni Agnoletti
BACKGROUND: Thoracic paravertebral block is a technique for perioperative analgesia in patients undergoing thoracic, chest wall, or breast surgery, or for pain management with rib fractures, which can be performed with or without ultrasound guidance. The ultrasound guidance technique can be used to identify the thoracic paravertebral space, guide needle placement, monitor the spread of local anesthetic (LA) solution, and reduce complications such as pleural puncture and pneumothorax. The possibility of assessing anesthetic spread in real time using ultrasound guidance during paravertebral block offers numerous advantages, including the immediate and accurate identification of the extent of nervous block, with a consequent reduction of LA dose...
March 1, 2018: Tumori
https://www.readbyqxmd.com/read/29708919/the-use-of-liposomal-bupivacaine-in-erector-spinae-plane-block-to-minimize-opioid-consumption-for-breast-surgery-a-case-report
#7
Amanda Kumar, Alina Hulsey, Hector Martinez-Wilson, James Kim, Jeff Gadsden
The erector spinae plane block is a novel interfascial plane block that can provide thoracic and abdominal analgesia. We describe a patient with opioid intolerance scheduled for breast surgery who received an erector spinae plane block with liposomal bupivacaine as well as a supplemental T1 paravertebral block resulting in profound analgesia throughout her postoperative course. This case report demonstrates that use of liposomal bupivacaine in the erector spinae plane block can be successful in providing extended duration postoperative analgesia and minimizing systemic opioid requirements...
May 1, 2018: A&A practice
https://www.readbyqxmd.com/read/29577505/efficacy-and-safety-of-bilateral-thoracic-paravertebral-blocks-in-outpatient-breast-surgery
#8
Linden K Head, Anne Lui, Kirsty Usher Boyd
Unilateral thoracic paravertebral blocks (TPVBs) have demonstrated reliable intraoperative analgesia, low postoperative pain scores, and an opioid-sparing effect in breast cancer surgery. However, secondary to the perceived risk of complications, bilateral TPVB have been less well accepted and are less frequently used. The purpose of this study was to evaluate the feasibility of using bilateral TPVBs in outpatient surgery for patients undergoing bilateral mastectomy with immediate implant-based reconstruction...
July 2018: Breast Journal
https://www.readbyqxmd.com/read/29416465/opioid-sparing-effects-of-the-thoracic-interfascial-plane-blocks-a-meta-analysis-of-randomized-controlled-trials
#9
REVIEW
Preet Mohinder Singh, Anuradha Borle, Manpreet Kaur, Anjan Trikha, Ashish Sinha
Background: Thoracic interfascial plane blocks and modification (PECS) have recently gained popularity for analgesic potential during breast surgery. We evaluate/consolidate the evidence on opioid-sparing effect of PECS blocks in comparison with conventional intravenous analgesia (IVA) and paravertebral block (PVB). Materials and Methods: Prospective, randomized controlled trials comparing PECS block to conventional IVA or PVB in patients undergoing breast surgery published till June 2017 were searched in the medical database...
January 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29327341/combined-thoracic-paravertebral-and-pectoral-nerve-blocks-for-breast-surgery-under-sedation-a-prospective-observational-case-series
#10
A Pawa, J Wight, D N Onwochei, R Vargulescu, I Reed, L Chrisman, E Pushpanathan, A Kothari, K El-Boghdadly
Avoidance of general anaesthesia for breast surgery may be because of clinical reasons or patient choice. There is emerging evidence that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes. We conducted a prospective observational case series of 16 breast cancer surgeries performed under thoracic paravertebral plus pectoral nerve block with propofol sedation to demonstrate feasibility of technique, patient acceptability and surgeon satisfaction...
April 2018: Anaesthesia
https://www.readbyqxmd.com/read/29284840/effect-of-clonidine-as-adjuvant-in-thoracic-paravertebral-block-for-patients-undergoing-breast-cancer-surgery-a-prospective-randomized-placebo-controlled-double-blind-study
#11
Nairita Mayur, Anjan Das, Hirak Biswas, Subinay Chhaule, Surajit Chattopadhyay, Tapobrata Mitra, Sandip Roybasunia, Subrata Kumar Mandal
Background and Aims: Postoperative pain after breast cancer surgery is unavoidable. Thoracic paravertebral block (TPVB), a locoregional anesthetic technique, has been proven successful for postoperative pain management in different thoracic surgical procedures, such as thoracotomy, breast cancer surgeries. Clonidine, an adjuvant, in TPVB may enhance the quality and prolong the duration of analgesia. This prospective study was to evaluate the effectiveness of clonidine; administered with TPVB; in addition to conventional local anesthetic solution...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29189284/the-use-of-liposomal-bupivacaine-in-erector-spinae-plane-block-to-minimize-opioid-consumption-for-breast-surgery-a-case-report
#12
Amanda Kumar, Alina Hulsey, Hector Martinez-Wilson, James Kim, Jeff Gadsden
The erector spinae plane block is a novel interfascial plane block that can provide thoracic and abdominal analgesia. We describe a patient with opioid intolerance scheduled for breast surgery who received an erector spinae plane block with liposomal bupivacaine as well as a supplemental T1 paravertebral block resulting in profound analgesia throughout her postoperative course. This case report demonstrates that use of liposomal bupivacaine in the erector spinae plane block can be successful in providing extended duration postoperative analgesia and minimizing systemic opioid requirements...
November 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28982906/survival-analysis-of-patients-with-breast-cancer-undergoing-a-modified-radical-mastectomy-with-or-without-a-thoracic-paravertebral-block-a-5-year-follow-up-of-a-randomized-controlled-trial
#13
RANDOMIZED CONTROLLED TRIAL
Manoj Kumar Karmakar, Winnie Samy, Anna Lee, Jia Wei Li, Wing Cheong Chan, Phoon Ping Chen, Ban C H Tsui
AIM: This 5-year prospective follow-up of women randomized to general anesthesia (GA) with or without a thoracic paravertebral block (TPVB) examined the risk of local recurrence, metastasis and mortality after breast cancer surgery. PATIENTS AND METHODS: A total of 180 patients undergoing modified radical mastectomy were randomized to one of three study groups: standardized GA only; GA with a single-injection TPVB (s-TPVB) and placebo paravertebral infusion after surgery for 72-h; and GA plus with continuous TPVB (c-TPVB) for 72-h postoperatively...
October 2017: Anticancer Research
https://www.readbyqxmd.com/read/28721091/comparison-of-single-injection-ultrasound-guided-approach-versus-multilevel-landmark-based-approach-for-thoracic-paravertebral-blockade-for-breast-tumor-resection-a-retrospective-analysis-at-a-tertiary-care-teaching-institution
#14
Jagroop Singh Saran, Amie L Hoefnagel, Kristin A Skinner, Changyong Feng, Daryl Irving Smith
BACKGROUND: The role of thoracic paravertebral blockade (TPVB) in decreasing opioid requirements in breast cancer surgery is well documented, and there is mounting evidence that this may improve survival and reduce the rate of malignancy recurrence following cancer-related mastectomy. We compared the two techniques currently in use at our institution, the anatomic landmark-guided (ALG) multilevel versus an ultrasound-guided (USG) single injection, to determine an optimal technique. METHODS: We retrospectively reviewed records of patients who received TPVB from January 2013 to December 2014...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28631050/analgesia-nociception-index-ani-monitoring-in-patients-with-thoracic-paravertebral-block-a-randomized-controlled-study
#15
Nurseda Dundar, Alparslan Kus, Yavuz Gurkan, Kamil Toker, Mine Solak
The goal of the study was to evaluate the effectiveness of analgesia nociception index (ANI) monitoring during intraoperative period for patients with thoracic paravertebral block (TPVB) undergoing breast surgery under general anesthesia. This prospective randomized trial was performed after receiving ethics committee approval in 44 patients who were scheduled to undergo breast surgery under general anesthesia. TPVB was performed in the preoperative period using 20 mL of bupivacaine 0.25% at T4 level. Anesthesia maintenance was provided with sevoflurane in O2 : air mixture and remifentanil infusion...
June 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28489642/pupillary-reflex-for-evaluation-of-thoracic-paravertebral-block-a-prospective-observational-feasibility-study
#16
Baptiste Duceau, Mélanie Baubillier, Gaëlle Bouroche, Aline Albi-Feldzer, Christian Jayr
BACKGROUND: Although thoracic paravertebral block (TPVB) is recommended in major breast surgery, there is no gold standard to assess the success of TPVB. Pupillary dilation reflex (PDR) is the variation of the pupillary diameter after a noxious stimulus. The objective was to evaluate the feasibility of recording the PDR to assess analgesia in an anesthetized thoracic dermatome after TPVB. METHODS: This prospective, observational, single-center study included 32 patients requiring breast surgery under general anesthesia and TPVB...
October 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28217050/acoustic-puncture-assist-device%C3%A2-versus-conventional-loss-of-resistance-technique-for-thoracic-paravertebral-space-identification-clinical-and-ultrasound-evaluation
#17
Monaz Abdulrahman Ali, Ashraf Abualhasan Abdellatif
BACKGROUND: Acoustic puncture assist device (APAD™) is a pressure measurement combined with a related acoustic signal that has been successfully used to facilitate epidural punctures. The principal of loss of resistance (LOR) is similar when performing paravertebral block (PVB). We investigated the usefulness of APAD™ by comparing it with the conventional LOR techniques for identifying paravertebral space (PVS). SUBJECTS AND METHODS: A total of 100 women who were scheduled for elective breast surgery under general anesthesia with PVB were randomized into two equal groups...
January 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27847703/treatment-of-post-latissimus-dorsi-flap-breast-reconstruction-pain-with-continuous-paravertebral-nerve-blocks-a-retrospective-review
#18
Jonathan T Unkart, Jennifer A Padwal, Brian M Ilfeld, Anne M Wallace
OBJECTIVES: The addition of a perioperative continuous paravertebral nerve block (cPVB) to a single-injection thoracic paravertebral nerve block (tPVB) has demonstrated improved analgesia in breast surgery. However, its use following isolated post-mastectomy reconstruction using a latissimus dorsi flap (LDF) has not previously been examined. METHODS: We performed a retrospective review of patients who underwent salvage breast reconstruction with a unilateral LDF by a single surgeon...
October 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/27801748/a-severe-complication-after-ultrasound-guided-thoracic-paravertebral-block-for-breast-cancer-surgery-total-spinal-anaesthesia-a-case-report
#19
LETTER
Aline Albi-Feldzer, Baptiste Duceau, Williams Nguessom, Christian Jayr
No abstract text is available yet for this article.
December 2016: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/27746568/comparisons-of-single-injection-thoracic-paravertebral-block-with-ropivacaine-and-bupivacaine-in-breast-cancer-surgery-a-prospective-randomized-double-blinded-study
#20
Ashutosh Sahu, Rajnish Kumar, Mumtaz Hussain, Ajit Gupta, K H Raghwendra
BACKGROUND: Regional anesthesia using paravertebral block has been suggested as an ideal adjunct to general anesthesia for modified radical mastectomy. Paravertebral block is an effective management of peri-operative pain for Modified radical mastectomy, however, there are no established guidelines regarding what is the most suitable strategy when varying drugs and dosages between different groups. AIM: To evaluate the effectiveness of paravertebral block comparing the most frequently employed drugs in this procedure (bupivacaine vs ropivacaine)...
September 2016: Anesthesia, Essays and Researches
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