Eur J Anaesthesiol 2017; 34:596–601

ORIGINAL ARTICLE

Thoracic paravertebral block for postoperative pain

management after renal surgery
A randomised controlled trial
Maja Copik, Szymon Bialka, Andrzej Daszkiewicz and Hanna Misiolek

BACKGROUND Thoracic paravertebral block (ThPVB) com-
bined with general anaesthesia is used in thoracic and
general surgery. It provides effective analgesia, reduces
surgical stress response and the incidence of chronic post-
operative pain.
OBJECTIVE To assess the efficacy of ThPVB in reducing
opioid requirements and decreasing the intensity of pain after
renal surgery.
DESIGN A randomised, open label study.
SETTING A single university hospital. Study conducted from
August 2013 to February 2014.
PARTICIPANTS In total, 68 patients scheduled for elective
renal surgery (open nephrectomy or open nephron-sparing
surgery).
INTERVENTIONS Preoperative ThPVB with 0.5% bupiva-
caine combined with general anaesthesia, followed by post-
operative oxycodone combined with nonopioid analgesics as
rescue drugs. Follow-up period: 48 h.
MAIN OUTCOME MEASURES Total dose of postoperative
oxycodone required, pain intensity, occurrence of opioid
related adverse events, ThPVB-related adverse events and
patient satisfaction.
RESULTS A total of 68 patients were randomised into two
groups and, of these, 10 were subsequently excluded from
analysis. Patients in group paravertebral block (PVB; n ¼ 27)
had general anaesthesia and ThPVB, and those in group
general (anaesthesia) (GEN) (n ¼ 31) formed a control group
receiving general anaesthesia only. Compared with patients
in group GEN, patients who received ThPVB required 39%
less i.v. oxycodone over the first 48 h and had less pain at rest
(P < 0.01) throughout the first 24 h. Group PVB patients also
experienced fewer opioid-related adverse events and were
less sedated during the first 12 postoperative hours. Patients
in the PVB group had higher satisfaction scores at 48 h
compared with the control group. There were no serious
adverse events.
CONCLUSION In our study, preoperative ThPVB was an
effective part of a multimodal analgesia regimen for reducing
opioid consumption and pain intensity. Methods and drugs
used in both groups were well tolerated with no serious
adverse events. Compared with the control group, patients in
the ThPVB group reported increased satisfaction.
TRIAL REGISTRATION Clinical Trials NCT02840526.
Published online 20 July 2017

Introduction
Open renal surgery is associated with significant postop-
erative pain and this pain is most severe in the first 48 h.
To avoid respiratory and thromboembolic complications,
patients need effective analgesia. There are many models
of postoperative analgesia described in the literature,
including systemic opioid drugs, systemic nonsteroidal
anti inflamatory drugs (NSAIDs), and a variety of regional
anaesthesia techniques. A multimodal analgesia approach
is based on combining different modes of analgesia with
the addition of local or regional anaesthesia to maximise
the efficacy and minimise the risk of adverse events.1,2
Regional anaesthesia techniques are especially beneficial
and their safety is well established, including in children.3
One such regional anaesthesia technique is thoracic

From the Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry, Medical University of Silesia, Zabrze, Poland
Correspondence to Maja Copik, Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry, Medical University of Silesia, Zabrze,
Poland; SPSK 1 im. S. Szyszko ul. 3 Maja 13-15 41-800 Zabrze, Poland
Tel: +48 32 3704593; fax: +48 32 3704593; e-mail: maja.grzanka@gmail.com

0265-0215 Copyright ß 2017 European Society of Anaesthesiology. All rights reserved. DOI:10.1097/EJA.0000000000000673

Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.


paravertebral blockade (ThPVB). It is used frequently in
thoracic and general surgery and has been described in
the literature as providing significant pain relief. It has a
unique quality of causing a powerful afferent blockade
that eliminates somatosensory-evoked potentials4 and it
may have a preemptive analgesic effect.5 However,
ThPVB has not been investigated widely as a postopera-
tive analgesic technique for renal surgery. In our study,
we wished to examine whether systemic opioids and
NSAIDs combined with ThPVB can provide sufficient
analgesia after open renal surgery.
Methods
After approval by the ethics committee, written informed
consent was obtained from patients scheduled to undergo
elective open renal surgery (radical nephrectomy or
nephron-sparing surgery). Ethical approval for this study
(KNW/0022/KB1/22/13) was provided by the Ethics
Committee of Medical University of Silesia, Katowice,
Poland (Chairperson Professor M. Trusz-Gluza) on 26
March 2013. The study was registered on ClinicalTrials.-
gov as NCT02840526. The study was conducted in a
single university hospital (Samodzielny Publiczny Szpital
Kliniczny nr 1, Zabrze, S. Szyszko) from August 2013 to
December 2014.
Inclusion criteria were age between 18 and 75 years,
American Society of Anesthesiologists physical status
score I-III and BMI of 19 to 35. Exclusion criteria were
lack of consent, coagulation disorders, contraindications
to ThPVB, chronic use of analgesics, chronic pain, mental
illnesses, spinal deformities and advanced renal cancer
infiltrating the thoracic wall. The patients were randomly
assigned to one of two groups with computer-generated
numbers: patients in group paravertebral block (PVB)
had general anaesthesia and ThPVB, whereas patients in
group GEN formed a control group, receiving general
anaesthesia only. The authors of the study were respon-
sible for group allocation, enrolling and assigning patients
to interventions, performing the intervention and making
postoperative assessments. The physicians performing
the interventions and assessments were not blinded to
the treatment given.
In the PVB group, before the induction of general anaes-
thesia a single-shot ThPVB was performed at the T7 to
T10 level, approximately, 2.5 to 3 cm lateral to the tip of a
spinous process. A preblock ultrasound examination was
undertaken to assess the depth of the transverse process
and the pleura. An insulated 10 cm long needle was used
and this was connected to a peripheral nerve stimulator
with an initial set current of 2.5 mA. The current was
gradually reduced as the needle was inserted until the
appearance of visible intercostal muscles activity with a
current of 0.3 to 0.5 mA (paravertebral space identifica-
tion). Plain bupivacaine (0.3 ml kg –1) was then injected
after a negative aspiration test for air or blood. The
efficacy of the blockade to cold was checked after
Eur J Anaesthesiol 2017; 34:596–601
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Thoracic paravertebral block after renal surgery 597
20 min with a plastic ampoule of saline kept in the
freezer. Testing was symmetrical on both sides of thorax.
A difference in the sensation to cold between the blocked
and unblocked sides was taken to indicate an effective
block.
In both groups, general anaesthesia was induced with
midazolam 0.1 mg kg –1, propofol 2 mg kg –1, cisatracurium
0.15 mg kg –1 and fentanyl 1.5 mg kg –1. Patients were
intubated with a standard single-lumen endotracheal
tube (ETT RIM-40-ZARYS, Zabrze, Poland). Anaesthe-
sia was maintained with one minimal alveolar concentra-
tion (MAC1) sevoflurane. For surgical analgesia,
fractional doses of fentanyl 1 to 3 mg kg –1 were adminis-
tered if heart rate (HR) or mean blood pressure rose more
than 20% above the base-line value obtained just before
surgery commenced. Patients awoke from anaesthesia in
the postanaesthesia care unit (PACU) where extubation
was performed by an anaesthetist after administration of
incremental doses of atropine and neostigmine, as re-
quired. The baseline cardiovascular parameters pre-
sented were recorded on entry to the PACU.
The postoperative pain management schedule was iden-
tical in both groups. After surgery, if a patient complained
of pain then she/he was given i.v. oxycodone by an
anaesthetist before commencing the patient controlled
analgesia (PCA). This dose was titrated to achieve
adequate analgesia or until side effects occurred. Each
patient then commenced PCA. The PCA solution was
oxycodone (1 mg ml –1) and the PCA was programmed to
allow a self-administered bolus dose of 1 mg oxycodone
with a lockout time of 5 min. Additionally, patients were
given 1 g intravenous paracetamol every 6 h and 100 mg of
intravenous ketoprofen every 12 h.
The following were monitored for 48 h postoperatively:
HR, SBP, DBP, sedation level (Ramsay scale), pain
intensity at rest per visual analogue score (10 cm VAS:
0 ¼ no pain, 10 ¼ maximum pain imaginable), oxycodone
requirement during preselected time intervals and total
oxycodone requirement. Adverse events related to
ThPVB (local anaesthetic toxicity, pneumothorax, nerve
damage, inadvertent epidural anaesthesia, major haema-
toma or intravascular injection) and opioid-related
adverse events (including respiratory depression) were
also recorded for 48 h postoperatively using the overall
benefit of analgesics score (OBAS). The OBAS question-
naire is a simple assessment tool for pain intensity,
opioid-related adverse events and a patient’s satisfaction.
It was designed to guide postoperative pain therapy in
daily clinical practice and consists of seven questions,
each on a scale from 0 (not at all) to 4 (very much),
enabling a patient to rate their distress from pain, dizzi-
ness, nausea and vomiting, itching, sweating as well as
their satisfaction from their pain treatment. It has been
validated in four clinical trials.6 Last, patient satisfaction
regarding postoperative analgesia was assessed using a
 598 Copik et al.
5-point scale (5 Very satisfied, 4 Satisfied, 3 neither
satisfied nor dissatisfied, 2 dissatisfied, 1 very dissatisfied)
for 48 h postoperatively.
Statistical analysis
A minimum of 24 patients per group was estimated based
on the assumption that this would allow the detection of a
difference of 30% or more in oxycodone requirements
over 24 h with a power of 80% at a level of a ¼ 0.05.
Additional patients were recruited to allow for dropouts
and 68 were randomised.
Data with normal distribution and on an interval scale are
presented as mean  SD. Data with nonnormal distribu-
tions and ordinal data are presented as median with upper
and lower quartiles. Qualitative data are presented as
percentages. Normal distribution of the presented data
was evaluated by the Shapiro–Wilk test. For comparison
between the groups, student t-test was used for indepen-
dent variables (homogeneity of variances was tested with
Levene’s test) and Mann–Whitney U test for other data.
To compare dichotomous variables, we used x2 tests with
Yates correction where necessary. For the analysis of
variability of the parameters overtime and their differ-
ences between the groups we used parametric variance
analysis with repetitive measurements and post hoc
contrast analysis. A recursive weighted least squares
estimation method was used for fitting a regression model
of variability of studied data overtime. A P value less than
Fig. 1
Assessed for eligibility (n = 75)
Randomisation (n = 68)
Allocation
Allocated to intervention (n = 31)
♦ Received allocated intervention (n = 28)
♦ Did not receive allocated intervention
(failed block n = 1, re-operation n = 2)
Follow up
Discontinued intervention
(PCA device malfunction) (n = 1)
Analysis
Analysed (n = 27)
Consort flow diagram. PCA, patient controlled analgesia.
Eur J Anaesthesiol 2017; 34:596–601
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0.05 was considered statistically significant. P values were
corrected with Bonferroni correction for multiple com-
parisons. Data were analysed with Statistica 10.0 PL and
MS Office Excel.
Results
A total of 75 patients were screened and 68 were enrolled
into the study. In total, ten patients were subsequently
excluded from the analysis because of reoperation (n ¼ 2),
ICU admission (n ¼ 2), changing the extent of surgery
(n ¼ 1), block failure (n ¼ 1), equipment error (n ¼ 1) or
inadequate pain control (n ¼ 3). Thus, in total, 58 patients
completed the study, 27 in the PVB group and 31 in the
GEN group (Fig. 1). Patient characteristics are presented
in Table 1. With the exception of SBP, there was no
significant difference between the groups in their base-
line parameters. Compared to group GEN, the need for
postoperative oxycodone was lower in group PVB at all
time intervals up to 36 h (Table 2). Patients in the PVB
group required 39% less total opioid than the control
group (Table 2).
The analysis of variance for repeated measures for VAS
pain scores at rest showed that the PVB group had
significantly less pain than the GEN group at all time
intervals in the first 24 h (Table 3).
Patients in the PVB group had lower score on the Ramsay
sedation scale 12 h postoperatively (Fig. 2) and lower
Excluded: (n = 7)
♦ Not meeting inclusion criteria (n = 3)
♦ Declined to participate (n = 2)
♦ Other reasons (n = 2)
Allocated to intervention (n = 37)
♦ Received allocated intervention (n = 34)
♦ Did not receive allocated intervention
(changed type of surgery n = 1, re-operation n = 1,
ICU admission n = 1)
Discontinued intervention (adverse events) (n = 3)
Analysed (n = 31)
 Thoracic paravertebral block after renal surgery 599

Table 1 Patients characteristics

All patients n U 58 PVB n U 27 GEN n U 31 P value

Age (year) 60  10 59  9 61  10 0.31
Sex (female/male) 21/37 10/17 11/20 0.90
Height (m) 1.69  0.09 1.69  0,07 1.66  0.08 0.13
Weight (kg) 82  15 83  16 81  14 0.60
BMI (kg m –2) 28.8  4.2 28.6  4.5 28.9  4.0 0.81
ASA Score 2 [2 to 3] 2 [2 to 3] 2 [2 to 3] 0.40
Duration of surgery (min) 87.9  37.4 91  39 85  36 0.55
SBP (mmHg)a 131  18 122  15 139  17 0.002
DBP (mmHg)a 75  10 72  9 76  10 0.13
HR (beats min –1)a 70  11 69  10 70  9 0.67

Data are mean  SD, median [lower quartile to upper quartile] or n. ASA, American Society of Anesthesiologists; GEN, general anaesthesia alone; HR, heart rate; PVB,
paravertebral block. a Baseline cardiovascular parameters were recorded on entry to the postanaesthesia care unit.

OBAS at 24 h and 48 h after the surgery (P < 0.01;
Table 4).
We also noted higher patient satisfaction in the PVB
group 48 h postoperatively compared to the GEN group
(Fig. 3), as measured with a 5-point satisfaction scale.
No significant differences between the groups as regards
DBP and HR were noted during the postoperative fol-
low-up period. There were no serious adverse events
related to either the ThPVB or to opioid use. All com-
plications and adverse events were considered minor and
did not affect patient recovery.
Discussion
The primary finding of this prospective, randomised
study is that adequate analgesia can be achieved in
patients undergoing open renal surgery by a multimodal
approach combining opioids, nonopioid analgesics and a
single-shot preoperative ThPVB.
Patients treated with ThPVB and general anaesthesia had
significantly better analgesia compared to patients who
received general anaesthesia only. This better pain relief
is reflected in the lower SBP on entry to the PACU noted
in the ThPVB patients. Postoperative pain intensity was
decreased during the whole postoperative follow-up
period. Some have noted prolonged analgesia after a
single-shot ThPVB, exceeding the expected duration
the local anaesthetic (in this case bupivacaine):5,7,8
The reasons for this phenomenon remain unclear. An
extended duration of ThPVB possibly may be explained
by the relatively sparse vascularity of the paravertebral
space. The vascularity has an impact on drug uptake and
removal and reduced vascularity slows the removal of
drug and thus can increase the speed of onset and prolong
the duration of action. Another possible reason under
consideration is the strong blockade of afferent fibres
combined with reduced sympathetic chain conduction.
The extended duration of block is consistent with the
results of other authors who successfully used PVB with
different surgical procedures, for both surgical anaesthe-
sia and postoperative analgesia.9,10,11,12 There is also
evidence that PVB may have a preemptive effect and
thus can decrease the strength of nociceptive signals to
the central nervous system.5
The analgesic effects of a single-shot ThPVB can be
explained by the spread of the drug to adjacent levels
above or below the injection site via the intercostal space
(laterally) or the epidural space (medially) or a combina-
tion of these. The end effect is a somatic and sympathetic
nerve blockade that includes the posterior primary rami
of thoracic nerves over multiple dermatomes.13 An
investigation performed by Eason and Wyatt14 showed
that a single injection of 15 ml 0.375% bupivacaine into

Table 2 Oxycodone requirement (mg) in the postoperative period

in the PVB and GEN groups Table 3 VAS pain scores at rest in the postoperative period in the
PVB and GEN group
Time points [h] PVB GEN P value
0 0.9  2.36 4.7  3.93 <0.001 Time points [h] PVB GEN P value
1 4.0  5.23 11.1  3.19 <0.001 0 1.00  1.36 3.65  1.64 <0.001
2 5.8  6.90 13.7  6.82 <0.001 1 1.04  1.45 3.42  1.73 <0.001
4 8.6  9.43 17.5  8.72 <0.001 2 0.96  1.32 3.45  1.8 <0.001
8 9.7  9.00 20.1  8.88 <0.001 4 1.44  1.69 3.39  1.78 <0.001
12 11.7  7.84 19.1  9.01 <0.01 8 1.44  1.67 3.23  1.86 <0.001
24 16.7  8.59 21.3  7.68 <0.05 12 1.67  1.33 3.23  1.52 <0.001
36 17.9  7.41 23.9  9.02 <0.01 24 2.15  1.54 3.29  1.68 <0.01
48 18.2  7.05 21.7  8.28 0.092 36 2.22  1.45 2.97  1.47 0.058
Total oxycodone requirement [mg] 93.6  44.3 153.1  31.97 <0.001 48 2.33  1.11 2.74  1.37 0.221

Data are mean  SD. GEN, general anaesthesia alone; PVB, general anaesthesia Data are mean  SD. GEN, general anaesthesia alone; PVB, general anaesthesia
and thoracic paravertebral block. and thoracic paravertebral block.

Eur J Anaesthesiol 2017; 34:596–601

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 600 Copik et al.

Fig. 2

(a) (b)
100% 100%

90% 90%

% of patients at each level

80%
% of patients at each level

80%
70% 70%

of sedation
60%
of sedation

60%
50% 50%

40% 40%

30% 30%

20% 20%

10% 10%

0% 0%
Postoperative assessment times Postoperative assessment times
0h 12h 24h 48h 0h 12h 24h 48h
2 44.4% 85.2% 92.6% 100.0% 2 12.9% 54.8% 90.3% 93.5%
3 51.9% 14.8% 7.4% 0.0% 3 80.6% 45.2% 9.7% 6.5%
4 3.7% 0.0% 0.0% 0.0% 4 6.5% 0.0% 0.0% 0.0%

(a) Proportion of patients attaining a particular sedation score on the Ramsay scale in the PVB group. (b) Proportion of patients attaining a particular
sedation score on the Ramsay scale in the GEN group. PVB, paravertebral block.

the thoracic paravertebral space can spread over four events. A study by Richardson et al. 9 suggests that the
intercostal spaces. Similar spread has been shown by complication rate is not very high, ranging from 2.6% to
others.7,9,15,16 A somatic blockade covering a minimum 5%. These authors studied 367 patients after ThPVB and
of five dermatomes together with a sympathetic block of observed hypotension in 4.6%, vascular puncture in 3.8%,
over seven dermatomes can be achieved by an injection pleural puncture in 1.1% and pneumothorax in 0.5% of
of 15 ml 0.5% bupivacaine.14 Similarly, using 1.5 mg kg –1 cases.9 There is also a potential danger of complications
of 0.5% plain bupivacaine can produce a loss of sensation related to accidental and unrecognised dural puncture
at the injection level and a mean superior and inferior (high spinal anaesthesia or Horner syndrome).18 These
spread of 1.4 and 2.8 dermatomes, respectively.9 There is latter complications seem to be related to the medial
also evidence that suggests a single-site injection can be approach to ThPVB and the close proximity of the needle
as effective as multiple-site injections in achieving uni-
lateral sensory blockade extending over four to five Fig. 3
adjacent thoracic dermatomes, when using 15 to 20 ml
or 0.3 ml kg –1 0.375 to 0.5% bupivacaine.7,15,16 80%
% of patients at each satisfaction level

ThPVB is considered a technique that can be learned 70%

quite easily and has a high success rate. Moreover, the
60%
learning curve does not seem to depend on the person
performing the block or the number of blocks performed. 50%
The failure rate of ThPVB is in the region of 6 to 10%,
40%
which is comparable to other widely used regional anaes-
thesia techniques.17 In our study the incidence of block 30%
failure was 3.9%. Based on literature reports, the true
20%
complication rate of ThPVB is hard to establish because
there are few studies reporting complications and adverse 10%

0%
Table 4 OBAS score at 24 and 48 h in the PVB and GEN group Ramsay sedation levels
3 4 5
Group PVB GEN P value GEN+PVB 3.7% 25.9% 70.4%
24 h 4.0 [4.0 to 5.0] 6.0 [6.0 to 8.0] <0.01 GEN 19.4% 71.0% 9.7%
48 h 5.0 [4.0 to 5.0] 6.0 [5.0 to 8.0] <0.01
Proportion of patients attaining a particular satisfaction score in the
Data are median and interquartile range. GEN, general anaesthesia alone; OBAS,
PVB and GEN groups 48 h after the surgery. PVB, paravertebral block.
overall benefit of analgesics score; PVB, general anaesthesia and thoracic
paravertebral block.

Eur J Anaesthesiol 2017; 34:596–601

Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.

to the intervertebral foramen and the dural cuff. The
majority of reported complications tend to be minor and,
up to the present, there are no reports of fatal complica-
tions directly associated with ThPVB.18,19 We did not
observe any of the above mentioned complications or
adverse events.
In our study, the patients in the PVB group needed less
opioid (oxycodone) to achieve efficient analgesia com-
pared with the GEN group. Various studies show that
increased consumption of opioids can lead to opioid-
related adverse events like nausea/vomiting or sedation:
using opioid-sparing techniques can reduce the incidence
of these adverse events.20 We noted that patients in the
PVB group required 39% less total oxycodone than the
GEN group (93.6 mg vs. 153.1 mg, respectively), which is
consistent with the results of Kairaluoma et al.21 who
reported a 40% opioid sparing effect in the postoperative
period by using ThPVB for breast surgery. Reduced
opioid use is probably the reason for the lower sedation
scores observed in the PVB group in the first 12 h post-
operatively as well as the lower OBAS, which includes an
assessment of opioid-related adverse events.
With regard to patient satisfaction after surgery, post-
operative pain is a very important issue. In the present
study, patients who received ThPVB in combination
with general anaesthesia had greater satisfaction scores
48 h after the surgery, compared to the group of
patients who underwent general anaesthesia alone.
This is consistent with the results achieved by other
authors.21,22
The principle limitations of our study are that the
assessors were not blinded to the treatment groups
and the study group was not large. It would be benefi-
cial to confirm these results in a larger study. It would
also be advisable to record VAS scores at rest and
on movement.
In conclusion, for patients undergoing open renal sur-
gery, preoperative ThPVB, as a part of a multimodal
postoperative analgesia regimen, is effective in decreas-
ing postoperative pain and can provide a more comfort-
able postoperative course compared to general
anaesthesia only. In addition, by reducing opioid con-
sumption the side effects of opioids are also reduced.
The advantages of the presented analgesic regimen
could contribute to earlier mobilisation and hospital
discharge. The reduced requirements for systemic post-
operative analgesics, improved patient outcomes (less
opioid-related adverse events), and higher patient satis-
faction make multimodal postoperative pain manage-
ment based on ThPVB suitable for patients undergoing
open renal surgery.
Eur J Anaesthesiol 2017; 34:596–601
Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.
Thoracic paravertebral block after renal surgery 601
Acknowledgements relating to this article
Assistance with the study: none.
Financial support and sponsorship: this work was supported by the
Department of Anaesthesiology, SPSK 1 Zabrze, Medical Univer-
sity of Silesia
Conflicts of interest: none.
Presentation: preliminary data for this study were presented as a
poster presentation at the Euroanaesthesia meeting, 28 to 30 May
2016, London.
References
1 Kehlet H, Dahl JB. The value of ‘multimodal’ or ‘balanced analgesia’ in
postoperative pain treatment. Anesth Analg 1993; 77:1048–1056.
2 Misiołek H, Cettler M, Woroń J, et al. The 2014 guidelines for postoperative
pain management. Anaesthesiol Intensive Ther 2014; 46:221–244.
3 Rawicz M. Acute postoperative pain in children. Anaesthesiol Intensive
Ther 2015; 47:264–265.
4 Woolf CJ, Chong MS. Preemptive analgesia: treating postoperative pain by
preventing the establishment of central sensitization. Anesth Analg 1993;
77:362–379.
5 Lonnqvist PA. Preemptive analgesia with thoracic paravertebral blockade?
Br J Anaesth 2005; 95:727–728.
6 Lehmann N, Joshi GP, Dirkmann D, et al. Development and longitudinal
validation of the overall benefit of analgesia score: a simple
multidimensional quality assessment instrument. Br J Anaesth 2010;
105:511–518.
7 Kllein SM, Bergh A, Steele SM. Use of paravertebral block anaesthesia for
breast surgery. Anesth Analg 2000; 90:1402–1405.
8 Hura G, Knapik P, Misiolek H, et al. Sensory blockade after thoracic
paravertebral injection of ropivacaine or bupivacaine. Eur J Anaesthesiol
2006; 23:658–664.
9 Richardson J, Lönnqvist PA, Naja Z. Bilateral thoracic paravertebral block:
potential and practice. Br J Anaesth 2011; 106:164–171.
10 Ak K, Gursoy S, Duger C, et al. Thoracic paravertebral block for
postoperative pain management in percutaneous nephrolithotomy patients:
a randomized controlled clinical trial. Med Princ Pract 2013; 22:229–233.
11 Terheggen MA, Wille F, Borel Rinkes IH, et al. Paravertebral blockade for
minor breast surgery. Anesth Analg 2002; 94:355–359.
12 Naja Z, Ziade MF, Lönnqvist PA. Bilateral paravertebral somatic nerve block
for ventral hernia repair. Eur J Anaesthesiol 2002; 19:197–202.
13 Naja MZ, Ziade MF, Rajab ME, et al. Varying anatomical injection points
within the thoracic paravertebral space: effect on spread of solution and
nerve blockade. Anaesthesia 2004; 59:459–463.
14 Eason MJ, Wyatt R. Paravertebral thoracic block-a reappraisal.
Anaesthesia 1979; 34:638–642.
15 Cheema A SP, Ilsley D, Richardson S. A thermographic study of
paravertebral analgesia. Anaesthesia 1995; 50:118–121.
16 Lönnqvist PA, Bösenberg AT. Anatomical dissections are not obsolete:
Cadaver studies can still provide important information for regional
anaesthesia. Eur J Anaesthesiol 2014; 31:303–304.
17 Tighe SQ, Greene MD, Rajadurai N. Paravertebral block. Continuing
Education in Anaesthesia, Critical Care & Pain 2010; 10:133–137.
18 Misiołek H, Kucia H, Werszner M, et al. Total spinal anaesthesia as a
complication of thoracic paravertebral block. Case report. Anaesthesiol
Intensive Ther 2004; 3:200–202.
19 Gay GR, Evans JA. Total spinal anaesthesia following lumbar paravertebral
block: a potentially lethal complication. Anesth Analg 1971; 50:344–348.
20 Moussa AA. Opioid saving strategy: bilateral single-site thoracic
paravertebral block in right lobe donor hepatectomy. Middle East J
Anaesthesiol 2008; 19:789–801.
21 Kairaluoma PM, Bachmann MS, Korpinen AK, et al. Single-injection
paravertebral block before general anaesthesia enhances analgesia after
breast cancer surgery with and without associated lymph node biopsy.
Anesth Analg 2004; 99:1837–1843.
22 Kaya FN, Turker G, Basagan-Mogol E, et al. Preoperative multiple-injection
thoracic paravertebral blocks reduce postoperative pain and analgesic
requirements after video-assisted thoracic surgery. J Cardiothorac Vasc
Anesth 2006; 20:639–643.