Sopena-Zubiria L A, Fernández-Meré L A, Muñoz González F, Valdés Arias C
Hospital Universitario Central de Asturias (HUCA), Centro Residencia Covadonga, Oviedo.
Rev Esp Anestesiol Reanim. 2010 Jun-Jul;57(6):357-63. doi: 10.1016/s0034-9356(10)70248-6.
To describe the use of multiple-injection thoracic paravertebral blockade, with intravenous sedation, for anesthesia during reconstructive breast surgery.
Descriptive, prospective study in 100 scheduled operations for major reconstructive breast surgery. The paravertebral block was performed by means of 3 injections at the lower edges of the vertebral apophyses at T3-5. We recorded time performing the procedure, latency (time until block onset), dermatomes blocked, degree of effectiveness, conversion to general anesthesia, postoperative complications and pain, and patient satisfaction.
Dermatomes T3, T4, and T5 were blocked in 99% of the patients. The block took 7.39 minutes to perform and latency was 7.37 minutes. Postoperative analgesia with anti-inflammatory drugs was adequate for most patients. There were 3 cases of epidural diffusion, 10 patients with hypotension, 12 with postoperative nausea or vomiting, and 3 with symptoms of epidural blockade. Intravascular puncture occurred, without complications, in 3 cases. There were no cases of pneumothorax or intrathecal injection. Ninety-one percent of the patients declared they were satisfied or very satisfied with the technique.
Triple-injection paravertebral blocks, in which 3 fractions of the total anesthetic dose are delivered to block dermatomes T3-5 is an effective technique that is easy to perform and leads to few complications. Most patients express a high degree of satisfaction with this anesthetic technique.
描述在乳房重建手术中使用多次注射胸段椎旁阻滞联合静脉镇静进行麻醉的情况。
对100例计划进行的大型乳房重建手术进行描述性前瞻性研究。椎旁阻滞通过在T3 - 5椎体附件下缘进行3次注射来实施。我们记录了操作时间、潜伏期（直至阻滞起效的时间）、阻滞的皮节、有效性程度、转为全身麻醉的情况、术后并发症和疼痛以及患者满意度。
99%的患者T3、T4和T5皮节被阻滞。阻滞操作耗时7.39分钟，潜伏期为7.37分钟。大多数患者使用抗炎药物进行术后镇痛效果良好。有3例硬膜外扩散，10例患者出现低血压，12例出现术后恶心或呕吐，3例出现硬膜外阻滞症状。3例发生血管内穿刺，但无并发症。无气胸或鞘内注射病例。91%的患者表示对该技术满意或非常满意。
三次注射椎旁阻滞，即将总麻醉剂量的3部分用于阻滞T3 - 5皮节，是一种有效的技术，操作简便，并发症少。大多数患者对这种麻醉技术表示高度满意。
