Breast Surgery Using Thoracic Paravertebral Blockade and Sedation AloneReport as inadecuate




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Anesthesiology Research and PracticeVolume 2014 2014, Article ID 127467, 4 pages

Clinical Study

Department of Anaesthesia, South Devon Healthcare NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay TQ2 7AA, UK

Department of Anaesthesia, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK

Received 18 June 2014; Accepted 12 August 2014; Published 21 August 2014

Academic Editor: Enrico Camporesi

Copyright © 2014 James Simpson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Thoracic paravertebral block TPVB provides superior analgesia for breast surgery when used in conjunction with general anesthesia GA. Although TPVB and GA are often combined, for some patients GA is either contraindicated or undesirable. We present a series of 28 patients who received a TPVB with sedation alone for breast cancer surgery. Methods. A target controlled infusion of propofol or remifentanil was used for conscious sedation. Ultrasound guided TPVB was performed at one, two, or three thoracic levels, using up to 30 mL of local anesthetic. If required, top-up local infiltration analgesia with prilocaine 0.5% was performed by the surgeon. Results. Most patients were elderly with significant comorbidities and had TPVB injections at just one level 54%. Patient choice and anxiety about GA were indications for TVPB in 9 patients 32%. Prilocaine top-up was required in four 14% cases and rescue opiate analgesia in six 21%. Conclusions. Based on our technique and the outcome of the 28 patients studied, TPVB with sedation and ultrasound guidance appears to be an effective and reliable form of anesthesia for breast surgery. TPVB with sedation is a useful anesthetic technique for patients in which GA is undesirable or poses an unacceptable risk.





Author: James Simpson, Arun Ariyarathenam, Julie Dunn, and Pete Ford

Source: https://www.hindawi.com/



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