Paniagua P, Català E
Anesthesiology and Pain Clinic Service, University Hospital Santa Creu i Sant Pau, C/Sant Antoni McClaret 167, 08023 Barcelona, Spain.
Reg Anesth Pain Med. 2000 Nov-Dec;25(6):651-3. doi: 10.1053/rapm.2000.8459.
Thoracic paravertebral block (TPVB) is a unilateral analgesic technique that has been advocated in both acute and chronic thoracic and abdominal pain. Other blocks such as interpleural and epidural can be effectively used in pleuritic pain. This report illustrates that TPVB could also be effective for this kind of pain.
A 45-year-old man with acute pancreatitis was referred to the critical care unit 11 days after emergency admission with severe left pleural effusion and acute respiratory failure. His medical history revealed hypertension and chronic obstructive pulmonary disease (COPD); in addition, he was a heavy drinker and smoker. A pleuritic pain that only slightly improved with nonopioid analgesics and opioids resulted in the patient's increasing inability to eliminate bronchial secretions. In an attempt to avoid endotracheal intubation, the pain unit recommended a continuous paravertebral block. The block was performed at T9 on the left side. An initial bolus of 15 mL bupivacaine 0.25% was administered and a continuous infusion, initially at 5 mL/h, was increased up to 10 mL/h to achieve the desired analgesic effect.
After the block the verbal analogue scale decreased from 9 to 3, and this level of pain relief was maintained until the end of the treatment 48 hours after the block. The patient improved and was discharged to the ward without the need for endotracheal intubation.
This case report supports the notion that, in practice, the paravertebral block could be an effective and safe alternative to relief of pleuritic pain.
胸段椎旁阻滞（TPVB）是一种单侧镇痛技术，已被推荐用于急慢性胸腹部疼痛。其他阻滞如肋间阻滞和硬膜外阻滞可有效用于胸膜炎性疼痛。本报告表明TPVB对这类疼痛也可能有效。
一名45岁急性胰腺炎男性患者，在因严重左侧胸腔积液和急性呼吸衰竭紧急入院11天后被转入重症监护病房。他的病史显示有高血压和慢性阻塞性肺疾病（COPD）；此外，他是重度饮酒者和吸烟者。非阿片类镇痛药和阿片类药物仅使胸膜炎性疼痛稍有改善，导致患者清除支气管分泌物的能力逐渐下降。为避免气管插管，疼痛科建议进行连续椎旁阻滞。在左侧T9水平进行阻滞。首先给予15 mL 0.25%布比卡因初始推注量，并开始持续输注，初始速度为5 mL/h，逐渐增加至10 mL/h以达到所需的镇痛效果。
阻滞后，视觉模拟评分从9分降至3分，且这种疼痛缓解程度一直维持到阻滞后48小时治疗结束。患者病情好转，无需气管插管即出院至病房。
本病例报告支持这样一种观点，即在实际应用中，椎旁阻滞可能是缓解胸膜炎性疼痛的一种有效且安全的替代方法。
