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Paravertebral block: anatomy and relevant safety issues

대한마취과학회지 2020년 73권 5호 p.394 ~ 400
Ardon Alberto E., Lee Justin, Franco Carlo D., Riutort Kevin T., Greengrass Roy A.,
소속 상세정보
 ( Ardon Alberto E. ) - Mayo Clinic Department of Anesthesiology and Perioperative Medicine
 ( Lee Justin ) - Providence St. Peter Hospital Department of Anesthesiology
 ( Franco Carlo D. ) - John H. Stroger Jr. Hospital of Cook County Department of Anesthesiology and Pain Management
 ( Riutort Kevin T. ) - Mayo Clinic Department of Anesthesiology and Perioperative Medicine
 ( Greengrass Roy A. ) - Mayo Clinic Department of Anesthesiology and Perioperative Medicine

Abstract


Paravertebral block, especially thoracic paravertebral block, is an effective regional anesthetic technique that can provide significant analgesia for numerous surgical procedures, including breast surgery, pulmonary surgery, and herniorrhaphy. The technique, although straightforward, is not devoid of potential adverse effects. Proper anatomic knowledge and adequate technique may help decrease the risk of these effects. In this brief discourse, we discuss the anatomy and technical aspects of paravertebral blocks and emphasize the importance of appropriate needle manipulation in order to minimize the risk of complications. We propose that, when using a landmark-based approach, limiting medial and lateral needle orientation and implementing caudal (rather than cephalad) needle redirection may provide an extra margin of safety when performing this technique. Likewise, recognizing a target that is not in close proximity to the neurovascular bundle when using ultrasound guidance may be beneficial.

키워드

Anatomy; Paravertebral; Postoperative pain; Regional anesthesia; Safety; Truncal nerve block

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