Thoracic Paravertebral Block

Excerpt

One of the leading causes of cancer mortality in both sexes is lung cancer. According to the American Cancer Society for Lung Cancer in the United States for 2020, it accounts for 25% of all cancer deaths.

84% of these lung cancers are non-small-cell lung cancer (NSCLC), and thoracic surgery, including pulmonary lobectomy, remains the treatment of choice for NSCLC. This surgery is associated with serious postoperative complications, such as respiratory distress, bleeding, and pain. This pain is responsible for a delay in revalidation with impaired patient quality of life.

According to a meta-analysis of prospective studies, the incidence of chronic pain at 3 and 6 months is 57% in patients who have had a thoracotomy because greater acute pain is associated with a greater likelihood of developing chronic pain.

Several studies have shown that the association of regional anesthesia in this type of surgery, such as thoracic paravertebral block (TPVB), will reduce postoperative opioids consumption and reduce the inflammatory response better postoperative survival.

First described by Hugo Sellheim 1905, who used this technique to produce abdominal analgesia. The TPVB has been neglected until 1979 when Eason and Wyatt published the utility of a catheter in paravertebral nerve block and showed its beneficial effect. Since then, its interest and impact in reducing postoperative pain for several thoracic surgical procedures have been reported by several authors.

This regional technique consists of local anesthetic injection in the paravertebral space near where the spinal nerves emerge from the intervertebral foramina. This allows somatic and sympathetic nerve blockage in several thoracic dermatomes.

This topic explains and describes the principles and importance of TPVB in thoracic surgical procedures and its implication in postoperative pain reduction.