Paravertebral Block: basics and cancer recurrence

 

From J Anaesthesiol Clin Pharmacol. 2011 Jan-Mar; 27(1): 5–11.

Why do paravertebral blocks?

• Journal of Anesthesiology Clinical Pharmacology – Paravertebral Blocks

Paravertebral blocks and decreased cancer recurrence

• BJA 2010 – Efficacy and Safety of Paravertebral Blocks in Breast Surgery: a meta-analysis of randomized clinical trials
• BJA 2010 – Effect of Anesthetic Technique and Other Perioperative Factors on Cancer Reccurence
• Anesthesiology 2006 – Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis?
• BJA 2012 – Can anesthetic and analgesic techniques affect cancer recurrence and risk?
• ASA: Paravertebral Block Ups Breast Cancer Surgery Outcomes

Paravertebral block techniques

From NYSORA

YouTube paravertebral block from LSORA

• Anesthesiology News – Paravertebral Blocks: The Evolution of a Standard of Care
• YouTube Ultrasound-Guided Paravertebral Block
• NYSORA – Paravertebral Block: Landmark Technique
• Paravertebral Block Landmark Technique
• NYSORA – Paravetebral Block: Ultrasound-Guided Technique

But wait… what about the potential side effects/adverse events from a paravertebral block?

Why not do a TIVA with propofol and dexmetetomedine and local anesthesia via surgeon?  Where’s that study to compare?

** Update **  July 20, 2016 –> What about the PEC 1&2 Blocks as well as Serratus block?

Prolonging blockade with adjuvants:

• IOSR J of Dental and Medical Sci; Dec 2015. Comparative study of bupiv with dexamethasone and bupi with clonidine through single space PVB for post op analgesia in thoracic and abdominal surgeries.
• 0.125% Bupiv + clonidine (1mcg/kg) vs 0.125% bupiv + dexamethasone (4mg): greater duration of analgesia in the dexamethasone group.