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Paravertebral block contraindications

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https://www.readbyqxmd.com/read/27790554/comparison-between-thoracic-epidural-block-and-thoracic-paravertebral-block-for-post-thoracotomy-pain-relief
#1
Soniya Biswas, Reetu Verma, Vinod Kumar Bhatia, Ajay Kumar Chaudhary, Girish Chandra, Ravi Prakash
INTRODUCTION: Postoperative pain after thoracotomy is being considered one of the most severe pain and if not treated well, can result in various respiratory and other complications. AIM: Present study was conducted with the aim to compare continuous thoracic epidural infusion with continuous paravertebral infusion for postoperative pain using Visual Analogue Scale (VAS) score and four point observer ranking. The secondary outcomes measured were pulmonary functions and any complication like hypotension, bradycardia, nausea, vomiting, urinary retention and neurological complications if any...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27650294/clinical-usefulness-of-pectoral-nerve-block-for-the-management-of-zoster-associated-pain-case-reports-and-technical-description
#2
Yeon-Dong Kim, Seon-Jeong Park, Junho Shim, Hyungtae Kim
The recently introduced pectoral nerve (Pecs) block is a simple alterative to the conventional thoracic paravertebral block or epidural block for breast surgery. It produces excellent analgesia and can be used to provide balanced anesthesia and as a rescue block in cases where performing a neuraxial blockade is not possible. In the thoracic region, a neuraxial blockade is often used to manage zoster-associated pain. However, this can be challenging for physicians due to the increased risk of hemodynamic instability in the upper thoracic level, and comorbid and contraindicated medical conditions such as coagulopathy...
September 20, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27242357/continuous-paravertebral-block-for-post-cardiothoracic-surgery-analgesia-a-systematic-review-and-meta-analysis
#3
Anje J Scarfe, Susanne Schuhmann-Hingel, Joanna K Duncan, Ning Ma, Yasoba N Atukorale, Alun L Cameron
A continuous paravertebral block is used when pain relief is required beyond the duration of a single-injection paravertebral block. Surgical procedures requiring an incision into the pleural cavity are some of the most painful procedures postoperatively and, if not managed appropriately, can lead to chronic pain. The current gold standard for post-cardiothoracic surgery pain management is epidural analgesia, which has contraindications, a failure rate of up to 12% and risk of complications such as epidural abscess and spinal haematoma...
May 30, 2016: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/27043787/application-of-continuous-wound-infusion-catheters-in-lung-transplantation-a-retrospective-data-analysis
#4
Nils Lenz, Markus Hirschburger, Rainer Roehrig, Thilo Menges, Matthias Mueller, Winfried Padberg, Valesco Mann
Background Lung transplantation is the only treatment option for many patients with end-stage pulmonary disease. Therefore, postthoracotomy pain therapy is of vital interest. Thoracic epidural analgesia (EPI) is the "gold standard" for postthoracotomy pain, but especially in lung transplantation contraindications, and potential infectious complications limit its advantages. Under these circumstances surgically placed postthoracotomy catheter-assisted continuous paravertebral intercostal nerve block (PVB) could be of advantage...
April 4, 2016: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/25503817/paravertebral-analgesia-in-video-assisted-thoracic-surgery-a-new-hybrid-technique-of-catheter-placement-for-continuous-anesthetic-infusion
#5
Ugo Cioffi, Federico Raveglia, Alessandro Rizzi, Piero Di Mauro, Matilde De Simone, Alessandro Baisi
Advantages of paravertebral analgesia in thoracotomy include the absence of morphine side effects and the lack of contraindications. We introduce a new technique for paravertebral catheter placement during video-assisted thoracic surgery. The catheter is placed in the same intercostal space as the camera port. Anesthetic is injected to reach the parietal pleura. The catheter is inserted through the needle and pushed until the paravertebral space is reached. Postoperative analgesia is performed by a continuous infusion of local anesthetics...
September 2015: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/25485914/interventional-modalities-to-treat-cancer-related-pain
#6
REVIEW
Susan M Moeschler, Casandra Rosenberg, Drew Trainor, Richard H Rho, W David Mauck
Cancer-related pain is a significant cause of morbidity in those affected by both primary and metastatic disease. Although oral, transdermal, and parenteral opioid medications are an integral part of the World Health Organization's analgesic ladder, their use may be limited by side effects. Fortunately, there are advanced interventional pain management strategies effective in reducing pain in the cancer patient while mitigating the aforementioned side effects. Celiac plexus blocks and neurolysis have been proven effective in treating cancers of the abdominal viscera (ie, pancreas)...
December 2014: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/25214832/breast-surgery-using-thoracic-paravertebral-blockade-and-sedation-alone
#7
James Simpson, Arun Ariyarathenam, Julie Dunn, Pete Ford
Introduction. Thoracic paravertebral block (TPVB) provides superior analgesia for breast surgery when used in conjunction with general anesthesia (GA). Although TPVB and GA are often combined, for some patients GA is either contraindicated or undesirable. We present a series of 28 patients who received a TPVB with sedation alone for breast cancer surgery. Methods. A target controlled infusion of propofol or remifentanil was used for conscious sedation. Ultrasound guided TPVB was performed at one, two, or three thoracic levels, using up to 30 mL of local anesthetic...
2014: Anesthesiology Research and Practice
https://www.readbyqxmd.com/read/24903040/-perioperative-pain-management-for-abdominal-and-thoracic-surgery
#8
REVIEW
J S Englbrecht, E M Pogatzki-Zahn
Abdominal and thoracic surgical procedures can result in significant acute postoperative pain. Present evidence shows that postoperative pain management remains inadequate especially after "minor" surgical procedures. Various therapeutic options including regional anesthesia techniques and systemic pharmacotherapy are available for effective treatment of postoperative pain. This work summarizes the pathophysiological background of postoperative pain after abdominal and thoracic surgery and discusses the indication, effectiveness, risks, and benefits of the different therapeutic options...
June 2014: Der Schmerz
https://www.readbyqxmd.com/read/24797238/a-comparison-of-the-analgesia-efficacy-and-side-effects-of-paravertebral-compared-with-epidural-blockade-for-thoracotomy-an-updated-meta-analysis
#9
REVIEW
Xibing Ding, Shuqing Jin, Xiaoyin Niu, Hao Ren, Shukun Fu, Quan Li
OBJECTIVE: The most recent systematic review and meta-analysis comparing the analgesic efficacy and side effects of paravertebral and epidural blockade for thoracotomy was published in 2006. Nine well-designed randomized trials with controversial results have been published since then. The present report constitutes an updated meta-analysis of this issue. SUMMARY OF BACKGROUND: Thoracotomy is a major surgical procedure and is associated with severe postoperative pain...
2014: PloS One
https://www.readbyqxmd.com/read/24216528/the-state-of-the-art-in-preventing-postthoracotomy-pain
#10
REVIEW
Alan Romero, Jose Enrique L Garcia, Girish P Joshi
Pain after thoracic surgery can be intense and prolonged. Inadequate pain management can have several detrimental effects, including increased postoperative morbidity and delayed recovery as well as occurrence of postthoracotomy syndrome. Therefore, establishing an adequate analgesic regimen for thoracic surgery is critical. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapies for postthoracotomy analgesia. When these techniques are either contraindicated or not possible, intercostal analgesia or intrathecal opioids are recommended...
2013: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/24183908/analgesia-in-patients-undergoing-thoracotomy-epidural-versus-paravertebral-technique-a-randomized-double-blind-prospective-study
#11
RANDOMIZED CONTROLLED TRIAL
Federico Raveglia, Alessandro Rizzi, Andrea Leporati, Piero Di Mauro, Ugo Cioffi, Alessandro Baisi
BACKGROUND: Pain control after thoracotomy prevents postsurgical complications and improves respiratory function. The gold standard for post-thoracotomy analgesia is the epidural catheter. The aim of this study was to compare it with a new technique that involves placement of a catheter in the paravertebral space at the end of surgery under a surgeon's direct vision. METHODS: From November 2011 to June 2012, 52 patients were randomized into 2 groups depending on catheter placement: an epidural catheter for group A and a paravertebral catheter for group B...
January 2014: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/23152701/thoracic-paravertebral-block-versus-transversus-abdominis-plane-block-in-major-gynecological-surgery-a-prospective-randomized-controlled-observer-blinded-study
#12
Andrey L Melnikov, Steinar Bjoergo, Ulf E Kongsgaard
BACKGROUND AND OBJECTIVES: Patients undergoing abdominal surgery often receive an epidural infusion for postoperative analgesia. However, when epidural analgesia is contraindicated or unwanted, the administration of opioids is the usual means used to relieve pain. Various regional analgesia techniques used in conjunction with systemic analgesia have been reported to reduce the cumulative postoperative opioid consumption and opioid-induced side effects. The objective of this trial was to assess the effectiveness of transversus abdominis plane block and paravertebral block in women undergoing major gynecological surgery...
2012: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/22327109/subpleural-block-is-less-effective-than-thoracic-epidural-analgesia-for-post-thoracotomy-pain-a-randomised-controlled-study
#13
RANDOMIZED CONTROLLED TRIAL
Ghassan E Kanazi, Chakib M Ayoub, Marie Aouad, Faraj Abdallah, Pierre M Sfeir, Almoataz-Billah F Adham, Mohamad F El-Khatib
CONTEXT: Thoracic epidural and paravertebral blocks provide adequate analgesia for postoperative thoracotomy pain. Both procedures are usually performed percutaneously with considerable failure rates. A subpleural catheter placed in the space posterior to the parietal pleura and alongside the paravertebral area may provide superior postoperative pain relief. OBJECTIVE: To compare subpleural analgesia with thoracic epidural analgesia in patients undergoing thoracotomy...
April 2012: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/22274769/free-flap-scalp-reconstruction-in-a-91-year-old-patient-under-local-regional-anesthesia-case-report-and-review-of-the-literature
#14
REVIEW
Joseph Nicholas Carey, Andrew J Watt, Oscar Ho, Kamakshi Zeidler, Gordon Kwanlyp Lee
In the elderly population with significant medical comorbidities, the safety of general anesthesia is often in question. In the head and neck, where regional and extradural anesthesia are not options, reconstruction of defects requiring free tissue transfer becomes a particular challenge for patients in whom general anesthesia is contraindicated. We present a case of a scalp reconstruction utilizing a latissimus dorsi free flap in a 91-year-old man performed entirely under local and regional anesthesia. General anesthesia was contraindicated secondary to the patient's multiple medical comorbidities...
March 2012: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/21377888/intra-operative-paravertebral-block-for-postoperative-analgesia-in-thoracotomy-patients-a-randomized-double-blind-placebo-controlled-study
#15
REVIEW
Olivier Helms, Juliette Mariano, Jean-Gustave Hentz, Nicola Santelmo, Pierre-Emmanuel Falcoz, Gilbert Massard, Annick Steib
OBJECTIVE: Epidural analgesia is the gold standard for post-thoracotomy pain relief but is contraindicated in certain patients. An alternative is paravertebral block. We investigated whether ropivacaine, administered through a paravertebral catheter placed by the surgeon, reduced postoperative pain. METHODS: In a randomized double-blind study, adult patients with a paravertebral catheter placed by the thoracic surgeon after thoracotomy were randomly assigned to receive through this catheter, either a 0...
October 2011: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/21241416/ultrasound-guided-bilateral-paravertebral-continuous-nerve-blocks-for-a-mildly-coagulopathic-patient-undergoing-exploratory-laparotomy-for-bowel-resection
#16
Mihaela Visoiu, Charles Yang
Regional anesthesia techniques commonly utilized in post-operative pain management are often considered contraindicated in coagulopathic patients. We report on successful postoperative pain control utilizing peripheral nerve blockade after exploratory laparotomy with small bowel resection in a mildly coagulopathic patient. In our case, complicated by abnormal PT, PTT and INR, a thromboelastogram (TEG) was performed before the procedure and found to be normal. An ultrasound-guided bilateral paravertebral blockade with continuous paravertebral catheters was then performed in this pediatric patient without complications...
April 2011: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/21233114/bilateral-thoracic-paravertebral-block-potential-and-practice
#17
REVIEW
J Richardson, P A Lönnqvist, Z Naja
Paravertebral nerve blocks (PVBs) can provide excellent intraoperative anaesthetic and postoperative analgesic conditions with less adverse effects and fewer contraindications than central neural blocks. Most published data are related to unilateral PVB, but its potential as a bilateral technique has been demonstrated. Bilateral PVB has been used successfully in the thoracic, abdominal, and pelvic regions, sometimes obviating the need for general anaesthesia. We have reviewed the use of bilateral PVB in association with surgery and chronic pain therapy...
February 2011: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/19237975/update-on-the-role-of-paravertebral-blocks-for-thoracic-surgery-are-they-worth-it
#18
REVIEW
David J Daly, Paul S Myles
PURPOSE OF REVIEW: To consider optimal analgesic strategies for thoracic surgical patients. RECENT FINDINGS: Recent studies have consistently suggested analgesic equivalence between paravertebral and thoracic epidural analgesia. Complications appear to be significantly less common with paravertebral analgesia. SUMMARY: There is good evidence that paravertebral block can provide acceptable pain relief compared with thoracic epidural analgesia for thoracotomy...
February 2009: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/18953284/analgesia-in-thoracic-surgery-review
#19
REVIEW
G De Cosmo, P Aceto, E Gualtieri, E Congedo
Post-thoracotomy pain is one of the most severe types of postoperative pain. It can last up to 2 months and can become chronic in 30% of patients. Pain relief after thoracic surgery is of particular significance, not only for ethical considerations but also for reduction of postoperative pulmonary and cardiac complications. Because of the difficulty in pain control, many approaches have been suggested, but a multimodal therapeutic strategy that provides a central or peripheral block associated with nonsteroidal anti-inflammatory (NSAID) and adjuvant drugs is now the cornerstone of treatment, offering the possibility of reducing opioid requirements and side effects...
June 2009: Minerva Anestesiologica
https://www.readbyqxmd.com/read/18713924/a-systematic-review-of-randomized-trials-evaluating-regional-techniques-for-postthoracotomy-analgesia
#20
REVIEW
Girish P Joshi, Francis Bonnet, Rajesh Shah, Roseanne C Wilkinson, Frederic Camu, Barrie Fischer, Edmund A M Neugebauer, Narinder Rawal, Stephan A Schug, Christian Simanski, Henrik Kehlet
BACKGROUND: Thoracotomy induces severe postoperative pain and impairment of pulmonary function, and therefore regional analgesia has been intensively studied in this procedure. Thoracic epidural analgesia is commonly considered the "gold standard" in this setting; however, evaluation of the evidence is needed to assess the comparative benefits of alternative techniques, guide clinical practice and identify areas requiring further research. METHODS: In this systematic review of randomized trials we evaluated thoracic epidural, paravertebral, intrathecal, intercostal, and interpleural analgesic techniques, compared to each other and to systemic opioid analgesia, in adult thoracotomy...
September 2008: Anesthesia and Analgesia
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