Simpson James, Ariyarathenam Arun, Dunn Julie, Ford Pete
Department of Anaesthesia, South Devon Healthcare NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay TQ2 7AA, UK ; Department of Anaesthesia, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK.
Department of Anaesthesia, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK.
Anesthesiol Res Pract. 2014;2014:127467. doi: 10.1155/2014/127467. Epub 2014 Aug 21.
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.
引言。胸段椎旁阻滞（TPVB）与全身麻醉（GA）联合使用时，可为乳腺手术提供更好的镇痛效果。尽管TPVB和GA常联合使用，但对于一些患者，GA要么是禁忌的，要么是不理想的。我们报告了一系列28例仅接受TPVB联合镇静用于乳腺癌手术的患者。方法。采用靶控输注丙泊酚或瑞芬太尼进行清醒镇静。在超声引导下于一个、两个或三个胸段水平进行TPVB，使用多达30 mL局部麻醉药。如有需要，外科医生用0.5%丙胺卡因进行追加局部浸润镇痛。结果。大多数患者为老年患者，合并症严重，仅在一个水平进行TPVB注射（54%）。9例患者（32%）选择TPVB的原因是患者自身选择以及对GA的焦虑。4例（14%）患者需要追加丙胺卡因，6例（21%）患者需要补救性阿片类镇痛。结论。基于我们的技术以及所研究的28例患者的结果，超声引导下TPVB联合镇静似乎是一种用于乳腺手术的有效且可靠的麻醉方式。对于GA不理想或存在不可接受风险的患者，TPVB联合镇静是一种有用的麻醉技术。
