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Awake open biopsy of a large anterior mediastinal tumor under thoracic paravertebral nerve block as the sole anesthetic

Background and aims: Mediastinal tumors can cause life-threatening complications during general anesthesia (GA). Several studies have demonstrated that thoracic paravertebral nerve block (TPVB) is adequate for use as the sole anesthetic for various surgical procedures. The aim of this study was to determinethe use of TPVB as the sole anesthetic for parasternal anterior mediastinostomy in 8 patients. Methods: After written informed consent, 8 patients ASA class IV with a large superior and middle anterior mediastinal tumor scheduled for anterior mediastinotomy and the biopsy. All patients were administered preoperatively 5 mg of oral diazepam. It was elected to use TPVB repeated at each dermatome level. All patients were in a sitting position, 8 ml of 2% lidocaine was administered subcutaneously. Using a 10-cm long 22-gauge Tuohy spinal needle and a loss of resistance technique, single punctures of the 4 paravertebral spaces from T2-T5 were performed. After aspiration, 5 ml of 0, 5% bupivacaine per segment was administered. Before starting the incision, 0, 05 mg of alfentanil and 1 mg of midazolam were administered intravenously. Results: In all patients onset of sensory loss occurred approximately 25 minutes after the injections. During the operations, the patients were awake, did not experience pain, and were hemodynamically stable and spontaneously breathing. Excellent analgesic effect was achieved. Conclusions: The use of a TPVB as the sole anesthetic for anterior mediastinotomy and the biopsy of anterior mediastinal mass resulted in adequate unilateral anesthesia. It was safe to use in high-risk patients in whom GA should have been avoided.

Thoracic paravertebral nerve block; Anesthesia; Analgesia; Mediastinotomy; Thoracic surgery; Thoracic anesthesia

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