Kirvelä O, Antila H
Department of Anaesthesiology, Turku University Hospital, Finland.
Reg Anesth. 1992 Nov-Dec;17(6):348-50.
Chronic postoperative pain in thoracic dermatomes is common. The most frequently used methods of pain relief in this area are posterior multidermatomal intercostal nerve or thoracic epidural blocks. Compared with these methods, thoracic paravertebral block may have some advantages. Usually only one injection is needed, and the use of larger volumes of local anesthetic (up to 25 ml) results in widespread unilateral analgesia including sympathetic block without the potential risk of hypotension and motor block associated with epidural block.
We retrospectively analyzed 281 thoracic paravertebral blocks performed for chronic postoperative pain (post-thoracotomy and postmastectomy) from 1986 to 1990 in our pain clinic.
In post-thoracotomy group, patients were without pain for at least a month after 58% of the blocks; in 30%, the effect lasted for at least two months; in 8%, more than four months and, in 3%, more than five months. In 88% of patients with postmastectomy pain, the achieved pain relief with thoracic paravertebral block was less than a month. No severe complications occurred.
Thoracic paravertebral block proved to be a reliable and safe technique for unilateral pain relief in chronic post-thoracotomy pain.
胸段皮节慢性术后疼痛很常见。该区域最常用的止痛方法是后位多皮节肋间神经阻滞或胸段硬膜外阻滞。与这些方法相比，胸段椎旁阻滞可能具有一些优势。通常只需注射一次，使用较大剂量的局部麻醉药（可达25毫升）可产生广泛的单侧镇痛，包括交感神经阻滞，而没有硬膜外阻滞相关的低血压和运动阻滞风险。
我们回顾性分析了1986年至1990年在我们疼痛门诊为慢性术后疼痛（开胸术后和乳房切除术后）进行的281例胸段椎旁阻滞。
在开胸术后组中，58%的阻滞术后患者至少一个月无痛；30%的患者效果持续至少两个月；8%的患者超过四个月，3%的患者超过五个月。在88%的乳房切除术后疼痛患者中，胸段椎旁阻滞实现的疼痛缓解持续不到一个月。未发生严重并发症。
胸段椎旁阻滞被证明是一种可靠且安全的技术，用于缓解开胸术后慢性疼痛的单侧疼痛。
