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지속적 흉부 척추옆블록에 의한 개흉술 후 통증관리

Continuous Thoracic Paravertebral Block for Pain Management Following Thoracotomy

박종민|윤건중|오세철|윤여옥
대한통증학회 (The Korean Pain Society)|2004.12|The Korean Journal of Pain|제17권 제2호|pp. 19-19

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Abstract

Background: Continuous thoracic paravertebral block (C-TPVB) produces multidermatomal, ipsilateral, somatic and sympathetic nerve blockade, and is one of the options for pain management following thoracotomy. Herein, our experience of a continuous paravertebral infusion of ropivacaine for pain management following a thoracotomy is reported. Methods: Thirty two patients who underwent a thoracotomy were investigated. TPVB was performed using the Eason and Wyatt's technique at the T3-4 or T4-5 intervertebral space with an 18 G, 8 cm Tuohy needle. An epidural catheter was placed into the TPVS through the 18 G Tuohy needle, and advanced 4-5 cm into the TPVS. Eight ml of 1% mepivacaine was injected into the thoracic paravertebral space (TPVS) and the dermatomal level checked by cold sensation. After the TPVB, general anesthesia was performed. When the visceral pleural had been closed, 8 ml of 0.3% ropivacaine was injected through the catheter, and 4 ml/h of 0.3% ropivacaine 0.3% continuous infused. The postoperative pain visual analog scale (VAS) was checked 2, 8, 24 and 48 hours after the operation in the resting and coughing states. Also, the requirements of the total dose of analgesic drug were recorded. The range of arm motion at the thoracotomy site, the side effects and patients' satisfaction were checked. Results: The mean VAS scores were 3.0 ± 1.1 and 3.2 ± 1.0 in the resting and coughing states, respectively, but there was no significant difference between the two states. The mean degree of arm motion was 1.47 ± 0.5 and the patient satisfaction was good. Conclusions: Our results suggest that continuous thoracic paravertebral block with ropivacaine is an effective method for providing continuous pain relief in patients undergoing a unilateral thoracotomy.

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