Bloc paravert

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Bloc paravertébral

• Eason MJ, Wyatt R Paravertebral thoracic block-a
  reappraisal. Anaesthesia 1979 3463842

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Thoracic Paravertebral Block Manoj K. Karmakar
Anesthesiology 2001 9577180
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Marret, Ann Thorac Surg 2005792109 14
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Paravertebral Block With Ropivacaine 0.5 Versus
Systemic Analgesia for Pain Relief After
Thoracotomy Marret E, Ann Thorac Surg
2005792109 14
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Paravertebral Ropivacaine, 0.3, and Bupivacaine,
0.25, Provide Similar Pain Relief After
Thoracotomy Marta García Navlet et al. Journal
Cardiothor Vasc Anesth Vol 20, 5 (October), 2006
pp 644-647
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A comparison of the analgesic efficacy and side
effects of paravertebral versus epidural
blockadeA systematic review and meta-analysis of
randomized trials. Davies RG Br J Anaesth
96418-426, 2006
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Bloc Paravertébral

• Oui

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Péri thoracique et chirurgie cardiaque ?
Effects of thoracic epidural anesthesia on
coronary arteries and arterioles in patients with
coronary artery disease. Blomberg S et al.
Anaesthesiol 1990738407. Thoracic epidural
anesthesia improves global and regional left
ventricular function during stress-induced
myocardial ischemia in patients with coronary
artery disease. Kock M, Blomberg S et al. Anesth
Analg 19907162530. High thoracic epidural
anesthesia, but not clonidine, attenuates the
perioperative stress response via sympatholysis
and reduces the release of troponin T in patients
undergoing coronary artery bypass grafting.
Loick H et al. Anesth Analg 1999887019.
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• Sympatholyse
• Baisse de la VO2
• Effets anti-ischémiques
• Amélioration de la fonction diastolique
•  In patients with multivessel ischemic heart
  disease, TEA partly normalizes the myocardial
  blood flow in response to sympathetic
  stimulation. 
• Nygård E et al. Circulation. 20051112165-2170.

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Mortalité Morbidité cardiaque IDM
PAC 1.7 2.4

• British Cardiac Society, Heart 2003
• Baisse du risque de 1 4600 patients

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• Méta-analyse. Liu SS, Anesthesiol 2004 101
• 15 études, 1178 patients (PAC)

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Péri thoracique et chirurgie cardiaque ?

• Non

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AA, 103(6), December 2006, p 1592
The Use of Epidural Analgesia in Cardiac Surgery
Should Be Encouraged
Department of Anesthesiology Montreal General
Hospital McGill University Montreal, Canada
Hemmerling Department of Anesthesiology
University of Toronto Ontario, Canada
Djaiani University of Chicago Chicago, IL
Babb Department of Anesthesiology University of
Pittsburgh Pittsburgh, PA Williams
For patients undergoing cardiac surgery,
anesthesiologists should choose analgesic options
that focus more on minimizing risk than
maximizing the potential of unproven
benefits. Mark A. Chaney, MD Department of
Anesthesia and Critical Care University of
Chicago Chicago, Illinois
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Postoperative Analgesia After Major Spine
SurgeryPatient-Controlled Epidural Analgesia
VersusPatient-Controlled Intravenous
AnalgesiaSchenk R, Anesth Analg 2006103131117
Péri thoracique et neurochirurgie ?

• Ropivacaïne 0.125 sufentanil 1 µg/ml
• 14 ml/h, 5 ml, 15 min.

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• Postoperative Analgesia After Anterior
  Correction of
• Thoracic Scoliosis A Prospective Randomized
  Study , Comparing Continuous Double Epidural
  Catheter Technique With Intravenous Morphine.
• Blumenthal S, SPINE 2006 31, 15 16461651
• 2 KT perop, voie antérieure transforaminale
  (T4-5, T10-12)
• J0 Remifentanil
• J1 à 8H Ropivacaïne 0.3 4-8 ml dans chaque KT,
  puis 4-10 ml/h
• H3 stop Remifentanil
• Objectif bloc sensitif T2-T12

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Péri thoracique et neurochirurgie ?

• 2 KT valent mieux quun.