Breast surgery using thoracic paravertebral blockade and sedation alone

2.50
Hdl Handle:
http://hdl.handle.net/11287/593812
Title:
Breast surgery using thoracic paravertebral blockade and sedation alone
Authors:
Simpson, James; Ariyarathenam, Arun; Dunn, Julie; Ford, Pete
Abstract:
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.
Citation:
Anesthesiol Res Pract. 2014;2014:127467.
Publisher:
Hindawi
Journal:
Anesthesiology research and practice
Issue Date:
1-Aug-2014
URI:
http://hdl.handle.net/11287/593812
DOI:
10.1155/2014/127467
PubMed ID:
25214832
Additional Links:
http://www.hindawi.com/journals/arp/2014/127467/
Note:
This article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.
Type:
Journal Article
Language:
eng
ISSN:
1687-6962
Appears in Collections:
Anaesthetics; 2014 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorSimpson, Jamesen
dc.contributor.authorAriyarathenam, Arunen
dc.contributor.authorDunn, Julieen
dc.contributor.authorFord, Peteen
dc.date.accessioned2016-01-19T12:35:15Zen
dc.date.available2016-01-19T12:35:15Zen
dc.date.issued2014-08-01en
dc.identifier.citationAnesthesiol Res Pract. 2014;2014:127467.en
dc.identifier.issn1687-6962en
dc.identifier.pmid25214832en
dc.identifier.doi10.1155/2014/127467en
dc.identifier.urihttp://hdl.handle.net/11287/593812en
dc.description.abstractIntroduction. 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.en
dc.language.isoengen
dc.publisherHindawien
dc.relation.urlhttp://www.hindawi.com/journals/arp/2014/127467/en
dc.titleBreast surgery using thoracic paravertebral blockade and sedation aloneen
dc.typeJournal Articleen
dc.identifier.journalAnesthesiology research and practiceen
dc.description.noteThis article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.en

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