engleski

Ultrasound-guided thoracic paravertebral block (TPVB)

Background: Thoracic paravertebral block (TPVB) is the technique of injecting local anesthetic alongside the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramen leading to unilateral, segmental, somatic, and sympathetic nerve block of ipsilateral dermatoma, which is effective for anesthesia and in treating acute and chronic pain of unilateral origin from the chest and abdomen. The most common indications for TPVB are rib fractures, refractory angina pectoris, neuralgia of the thoracic wall and also cancer pain. Today’s understanding of the use and efficacy of TPVB increased interest in using the technique not only for analgesia but also for surgical anesthesia. The most common surgical indications are breast surgery, thoracic wall surgery and unilateral abdominal wall surgery. The introduction of ultrasound in the practice of regional anesthesia has led to the recognition of the need to increase consistency of TPVB. Methods: Preparation of the patient for TPVB begins with monitoring the patient's vital functions, reading the ECG, measuring arterial pressure, pulse oximetry, setting the venous pathway alongside with sedation with midazolam. The patient is seated, with a TPVB level by placing an ultrasound probe in craniocaudal orientation about 5 cm lateral to the median line, visualizing the ribs and transverse extensions of the vertebrae, bone transverse ligaments, and pleura between which the paravertebral space is located. The needle is introduced by the in-plain technique thus visualizing the needle as a whole ; by entering the tip of the needle into the PVS, a local anesthetic is applied to fill the paravertebral space, which is seen as a pleural drop. The local anesthetic used in practice is levobupivacaine 0.5% in a dose of 20 ml and the duration of anesthesia is 4-6 hours and analgesia 12-16 hours. Conclusion: In 2019, the University Hospital for Tumors, Sestre milosrdnice University Hospital Center started with the application of TPBV technique. The advantage of TPVB block under ultrasound control is an effective perioperative analgesia, non-induction of general anesthesia, as well as lower financial cost compared to general anesthesia. The reason for insufficient application in everyday practice is organizationally and time-consuming preparation and procedure. To achieve the highest possible application and success rate without the development of complications, it is necessary to educate the performance of TPVB technique in anesthesia.

TPVB ; analgesia ; anesthesia ; ultrasound

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