Application of a conventional paravertebral block on the thorax with a novel intrathoracic approach during the intraoperative period: Two case reports

Abstract

Pain management significantly reduces mortality by aiding in the effective elimination of secretions after thoracic surgery. We present two cases requiring emergency surgical intervention due to major trauma. Both patients were provided pain control with an intrathoracic approach of the paravertebral block performed by a sterile-clothed anesthetist with a single-shot 20 ml injection of 0.25% bupivacaine from the inner surface to the superior costo-transverse ligament (SCTL). After extubation, the measured VAS score was no higher than 3–4, and the patients could breathe and cough comfortably. The intrathoracic approach may be an effective method to implement for postoperative acute pain. '+st+' Helms O, Mariano J, Hentz JG, Santelmo N, Falcoz PE, Massard G, et al. Intra-operative paravertebral block for postoperative analgesia in thoracotomy patients: a randomized, double-blind, placebo-controlled study. Eur J Cardiothorac Surg. 2011;40(4):902-6. DOI: https://doi.org/10.1016/j.ejcts.2011.01.067 Yamauchi Y, Isaka M, Ando K, Mori K, Kojima H, Maniwa T, et al. Continuous paravertebral block using a thoracoscopic catheter-insertion technique for postoperative pain after thoracotomy: a retrospective case-control study. J Cardiothorac Surg. 2017;12(1):5. DOI: https://doi.org/10.1186/s13019-017-0566-8 Ali MA, Abdellatif AA. Acoustic puncture assist device versus conventional loss of resistance technique for thoracic paravertebral space identification: Clinical and ultrasound evaluation. Saudi J Anaesth. 2017;11(1):32-6. DOI: https://doi.org/10.4103/1658-354X.197368 Slade IR, Samet RE. Regional Anesthesia and Analgesia for Acute Trauma Patients. Anesthesiol Clin. 2018;36(3):431-54. DOI: https://doi.org/10.1016/j.anclin.2018.04.004 Krediet AC, Moayeri N, van Geffen GJ, Bruhn J, Renes S, Bigeleisen PE, et al. Different Approaches to Ultrasound-guided Thoracic Paravertebral Block: An Illustrated Review. Anesthesiology. 2015;123(2):459-74. DOI: https://doi.org/10.1097/ALN.0000000000000747 Costache I, de Neumann L, Ramnanan CJ, Goodwin SL, Pawa A, Abdallah FW, et al. The mid-point transverse process to pleura (MTP) block: a new end-point for thoracic paravertebral block. Anaesthesia. 2017;72(10):1230-6. DOI: https://doi.org/10.1111/anae.14004 Chin KJ. Thoracic wall blocks: From paravertebral to retrolaminar to serratus to erector spinae and back again - A review of evidence. Best Pract Res Clin Anaesthesiol. 2019;33(1):67-77. DOI: https://doi.org/10.1016/j.bpa.2019.02.003 Tulgar S, Ahiskalioglu A, Thomas DT, Gurkan Y. Should erector spinae plane block applications be standardized or should we revise nomenclature? Reg Anesth Pain Med. 2020;45(4):318-9. DOI: https://doi.org/10.1136/rapm-2019-100910 Kadomatsu Y, Mori S, Ueno H, Uchiyama M, Wakai K. Comparison of the analgesic effects of modified continuous intercostal block and paravertebral block under surgeon's direct vision after video-assisted thoracic surgery: a randomized clinical trial. Gen Thorac Cardiovasc Surg. 2018 Jul;66(7):425-31. doi: 10.1007/s11748-018-0936-8. Epub 2018 May 8. PMID: 29740737. DOI: https://doi.org/10.1007/s11748-018-0936-8 Zhang X, Shu L, Lin C, Yang P, Zhou Y, Wang Q, et al. Comparison Between Intraoperative Two-Space Injection Thoracic Paravertebral Block and Wound Infiltration as a Component of Multimodal Analgesia for Postoperative Pain Management After Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2015;29(6):1550-6. DOI: https://doi.org/10.1053/j.jvca.2015.06.013 Copyright (c) 2023 Ergun Mendes , Tolga Semerkant , Oya Yalcin Cok This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.