Journal of Medical and Surgical
Research (JMSR)


Pages: 667-672

Date of Publication: 30-Nov--0001

Ultrasound Guided Thoracic Paravertebral Block in Thoracic Surgery: -Observational Study-.

Author: Abderrahim El Bouazzaoui, Soumaya Touzani, Nawfal Houari, Brahim Bouykatta, Nabil Kanjaa

Category: JMSR Anesthesiology and IC

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Introduction:The paravertebral block (PVB) is a unilateral anesthesia of the trunk which showed its effectiveness in many surgical indications. The aim of this our study is to evaluate the interest of the PVB in the analgesia after thoracotomy. Methodology:All patients were older than 12 years old, and were to benefit from PVB for any thoracic surgery by thoracotomy. Data concerning the ultrasound locating of the paravertebral space, the puncture, the analgesics data according to the visual analogue scale (VAS), and complications of the technique were collected. Results: We had 16 patients, with a median age of 36 years old, were prospectively included over 8 months. The anatomical structures identified through ultrasound guidance were: the transverse process (100% of cases), the costo-transverse ligament (44%), the parietal pleura (100%). The needle was displayed throughout his trajectory in 81% of patients. The extremity of the needle is displayed in 93% of cases. The anterior displacement of the pleura was noted in 94% of cases. The mean VAS during the rest was [3, 73-0] for 48 hours and during effort has varied VAS average of [5.6 to 0.5]. The dose of morphine received during the 48heurs was 13mg. No complications were recorded. After extubation the mean VAS was 5 and the dose of morphine received in the post-operative room was 3.5 mg. Conclusion: The paravertebral block is a simplified technique allowing analgesia after major surgery of the thorax. This technique can thus advantageously replace thoracic epidural analgesia with fewer major complications.

Keywords: Analgesia, Chest pain, Pulmonary resection, Thoracic para-vertebral block, Thoracotomy



1. Marret E, Ohama M, Bonnet F. Le bloc para-vertébral. Ann Fr Anesth Réanim 2006; 25:249-252

2. Cowie B, McGlade D, Ivanusic J, et al. Ultrasound guided thoracic paravertebral blockade: a cadaveric study. Anesth Analg 2010; 110:1735-9.

3. Baidya DK, Khanna P, Maitra S. Analgesic efficacy and safety of thoracic paravertebral and epidural analgesia for thoracic surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2014 May; 18 (5):626-35.

4. Karmakar M.K. Thoracic paravertebral block. Anesthesiology 2001;95:771-80

5. Pauchet V, Sourdat P. L’anesthésie régionale. Paris:Doin 1914, pp118

6. Richardson J, Sabanathan S, Jones J, et al. A prospective, randomized comparison of preoperative and continuous balanced epidural of paravertebral bupivacaine on post thoracotomy pain, pulmonary function and stress responses. Br J Anaesth 1999; 83: 387-92

7. Francis Bonnet, Joe?lle Berger, Mihael Ott, Emmanuel Marret. Faut-il ressusciter le bloc paraverte?bral ? MAPAR, pp 43-50

8. Sabanathan S, Smith PJ, Pradhon GN, et al. Continuous intercostal nerve block for pain relief after thoracotomy. Ann Thorac Surg 1988; 46: 425-6.

9. Sabanthan S, Mearns AJ, Bickford Smith PJ et al. Efficacy of continuous extra pleural intercostals nerve block on post thoracotomy pain and pulmonary mechanics. Br J Surg 1990; 77: 221-5

10. Marret E, Bazelly B, Taylor G et al. Paravertebral block with ropivacaine 0.5 % versus systemic analgesia for pain relief after thoracotomy. Ann Thorac Surg 2005; 79: 2109-13

11. Burns DA, Ben-David B, Chelly JE, et al. Intercostally placed paravertebral catheterization: an alternative approach to continuous paravertebral blockade. Anesth Analg 2008 ; 107 : 339-41

12. Bouzinac A, Delbos A, Mazières M, et al. Intérêt de l’échographie dans la réalisation du bloc paravertébral thoracique en chirurgie mammaire. Ann Fr Anesth Reanim 2011; 30: 453-5.

13. Solier M, Liu N, Fischler M. Analgesia after thoracotomy: French practice. Ann Anesth Reanim 2004; 23: 681-8

14. Powell ES, Cook D, Pearce AC, et al. A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy. Br J Anaesth 2001; 106 (3):364-70.

15. Daly DJ, Myles PS. Update on the role of paravertebral blocks for thoracic surgery: are they worth it? Curr Opin Anaesthesiol. 2009; 22:38-43

16. Bimston DN, McGee JP, Liptay MJ, et al. Continuous paravertebral extrapleural infusion for post-thoracotomy pain management. Surgery 1999; 126: 650–6.

17. Joshi GP, Bonnet F, Shah Ret al. A systematic review of randomized trials evaluating regional techniques for post thoracotomy analgesia. Anesth Analg. 2008; 107: 1026-40

18. Pintaric TS, Potocnik I, Hadzic A, et al. Comparison of continuous thoracic epidural with paravertebral block on perioperative analgesia and hemodynamic stability in patients having open lung surgery. Reg Anesth Pain Med 2011; 36:256-60

19. Gulbahar G, Kocer B, Muratli SN, et al. A comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management. Eur J Cardiothorac Surg 2010;37:467-72

20. Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side effects of paravertebral versus epidural blockade for thoracotmy. a systemic review and meta-analysis of randomized trials. Br J Anaesth 2006; 96: 418-26

21. Powell ES, Cook D, Davies P. UK pneumonectomy outcome study (UKPOS): a prospective observational study of pneumonectomy outcome. J Cardiothorac Surg 2009; 4: 41

22. El Sayed H, Mc Kevith J, Mc Shane Jet al. Thoracic epidural or paravertebral bloc for thoracic surgery. J Cardiothorac Vasc Anesth 2012; 26: 78-82

23. Fortier S, Hanna HA, Bernard A, et al. Comparison between systemic analgesia, continuous wound catheter analgesia and continuous thoracic paravertebral block: a randomized, controlled trial of post thoracotomy pain management. Eur J Anaesthesiol 2012; 29: 524–30.