Libro degli atti 69° Congresso nazionale SIAARTI (Bologna, 14-17 ottobre 2015)

Translated title of the contribution: [Autom. eng. transl.] Book of acts 69th SIAARTI National Congress (Bologna, 14-17 October 2015)

Enrica Adducci, Elisabetta Gualtieri, Antonio Mascia, Paolo Primieri, Enzo Picconi

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

[Autom. eng. transl.] VALIDITY OF THE PARAVERTEBRAL BLOCK IN THORACIC SURGERY. CRITICAL REVISION OF OUR CASE STUDY E. Adducci, E. Picconi, E. Gualtieri, A. Mascia, P. Primieri Anesthesiology and Resuscitation - Catholic University of S. Cuore, Rome, Italy Introduction. Pain control in thoracic surgery as well as providing adequate patient comfort reduces the development of perioperative comorbidities and the possibility of developing chronic pain syndromes. The analgesic efficacy of a technique must go hand in hand with its safety, therefore, the aim of this study was to evaluate the efficacy of the thoracic paravertebral block and the incidence of complications. Materials and methods. In this retrospective study, all patients who underwent thoracotomy thoracic surgery in which our team performed an antalgic paravertebral block were examined. Patients enrolled in the study received standard general anesthesia. The paravertebral block was performed after induction in lateral decubitus with the liquid mandrel technique, using a Thuoy 18G needle, administering to T5-T6-T7, 5 ml of Ropivacaine 0.5% and 5mcg of sufentanil. Furthermore, a paravertebral catheter was positioned at T7 level and Ropivacaine 0.2% + sufentanil 1 mcg / ml was infused using an elastomeric pump at a rate of 5 ml / h, for a period of 48 hours. The technical difficulties, the complications related to the technique and the analgesic efficacy assessed by scoring on the VAS scale of the perceived pain intensity were examined. Results. 247 patients (M / F 177/70), mean age 62 ± 19 aa, class ASAI = 10%, ASAII = 55%, ASAIII = 33% ASAIV = 2%, affected by neoplasia in 96% and pathology benign in 4% of cases; subjected to lobectomy (60%), to atypical resections (34%), to pneumonectomies (6%). The average execution time of the block was 16.6 ± 12 min. The SEA trend is shown in Fig.1. In 7% of cases there was difficulty in positioning the catheter. In 17% of cases the catheterine was intrathoracic and was therefore repositioned by the surgeon. In 12% of cases there was insufficient analgesia (VAS above 5). In 4 cases the catheter was removed due to the presence of blood. In 6 cases the opioid in association was removed for itching. A case of marked hypotension was recorded which led to suspect a toxic effect from a local anesthetic resolved with sub-intensive treatment. Discussion. The paravertebral block is a valid analgesic technique even if some aspects must be underlined to minimize the side effects: bolus fractionated on several levels, continuous infusion less than 0.1 ml / kg / h, do not carry out the block in the presence of previous interventions in the region paravertebral, parietal pleura intact (1). We are also considering the possibility of avoiding the association opioid + local anesthetic to avoid the side effects related to the drug. The relative rapidity of execution and the reduced complications seem to be in favor of this technique which can also be proposed to clinically compromised patients. With the aim of reducing the ever-present risk of overdose, the minimum effective concentration and / or the most appropriate volume should be investigated with a wider range of cases. Bibliography: 1) Fibla JJ, Molins L, et al. A randomized prospective study of analgesic quality after thoracotomy: paravertebralblock with bolus versus continuous infusion with an elastomeric pump. Eur J Cardiothorac Surg. 2015 Apr; 47 (4): 631-5. 217
Translated title of the contribution[Autom. eng. transl.] Book of acts 69th SIAARTI National Congress (Bologna, 14-17 October 2015)
Original languageItalian
Title of host publicationLibro degli atti 69° Congresso nazionale SIAARTI (Bologna, 14-17 ottobre 2015)
Pages217
Number of pages1
Publication statusPublished - 2015
Event69° Congresso nazionale SIAARTI - BOLOGNA -- ITA
Duration: 14 Oct 201517 Oct 2015

Conference

Conference69° Congresso nazionale SIAARTI
CityBOLOGNA -- ITA
Period14/10/1517/10/15

Keywords

  • Blocco Paravertebrale
  • Chirurgia Toracica

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