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Postoperative paravertebral blocks for thoracic surgery.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Purcell-Jones, G. Justins, Douglas M. |
| Copyright Year | 1988 |
| Abstract | Sir,—We were particularly interested in the findings of Drs Conacher and Kokin's radiological study of paravertebral block [1], but feel that this is potentially misleading. Our observations from a continuing series of 45 cases of para-vertebral block contrast significantly with the findings in their small study. Using a modification of Moore's technique we have injected 0.75 % bupivacaine 5 ml, diluted with Conray 420, into the paravertebral space under x-ray control and observed the spread. We demonstrated a widespread distribution of contrast on A-P and lateral x-ray, as well as on CT scan, and this was confined to the paravertebral space in only 20 % of cases. We have concluded that extradural spread is of more than "the occasional relevance" implied by the authors since this occurred in 70% of the patients in our series. Furthermore, it contributed significantly to the sensory blockade, which was more widespread in those with extradural spread than in those in whom paravertebral distribution occurred alone. Bilateral radiological spread of contrast was usually associated with ipsilateral analgesia. We cannot agree with the authors' implication that disabling hypotension does not occur with paravertebral block. Profound hypotension, secondary to sympathetic blockade, occurred in 9 % of our patients and was not always associated with demonstrable extradural spread. We agree that the risk of intrapleural injection is substantial. However, none of the 7% with intrapleural spread in our series developed a pneumothorax. Pain relief in this latter group was very poor. It may be that the different spread of contrast that we have noted is related to the different patient population rather than minor variations in technique. Our patients were not post-operative thoracotomy cases with potentially distorted tissue planes, but Pain Relief Clinic patients with undisturbed paravertebral anatomy. This would not support the authors' contention that extradural spread occurs only in the presence of pathology (e.g. fractured ribs). We confirm the authors' finding that a single paravertebral injection provides excellent analgesia over several dermatomes, but the extent of the block is unpredictable and the risk of significant complications exists. We would also question the wisdom of paravertebral injection of neurolytic solutions—a technique sometimes advocated for terminal pain relief. Sir,—Thank you for showing me the informative and informed comments of Drs Purcell-Jones and Justins. The correspondents have perhaps been a bit journalistically destructive by not quoting the sentence about relevance in full. It was not our intention to deny … |
| Starting Page | 301 |
| Ending Page | 306 |
| Page Count | 6 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/bja/61/3/10.1093/bja/61.3.369-a/2/61-3-369b.pdf?Expires=1491699560&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q&Signature=MGhYyPs0bf4AQr18Bbjs4TvTtF52bzybjoQ21J2DgrXW9Kwd55~Gc7q50cmja58bG-FG6un9LKvbt3dTG3KtLpHKqg7ltbiNnt1WSZHMDjl6iGuxeqPeySF1TeQv6bKlOwwnQSWRxSWxAe9whZFAWN6NPOcunDS0~LlU8pyFK5nyiiipU-VEXjaFc8AJXUWwtQo3UBoSlCVlkfutm0kyewd2JmkjWTsYF5TuupurSUziLQimQNZecrMUW7wfZAMt7CjT-Ps848T7Rxlha5VyDTlxnfPkl2y9OSFj39SVZyN8IEecG32u77ocsSdypns95y6bASS~n2sfX3Jk2hHkHQ__ |
| PubMed reference number | 3179162v1 |
| Volume Number | 61 |
| Issue Number | 3 |
| Journal | British journal of anaesthesia |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Anatomic structures Atrioventricular Block Bone structure of rib Bone structure of spine Bupivacaine Chest Cutaneous Receptive Fields Drinking Restraint Scale Intrapleural Pain relief Paravertebral Block Patient-Controlled Analgesia Patients Pneumothorax Rib Fractures Roentgen Rays Thoracic Surgical Procedures Thoracotomy X-Ray Computed Tomography |
| Content Type | Text |
| Resource Type | Article |
