Bloc paravertébral

• Eason MJ, Wyatt R: Paravertebral thoracic block-a reappraisal. Anaesthesia 1979; 34:638–42

Thoracic Paravertebral BlockManoj K. Karmakar Anesthesiology 2001; 95:771–80

Marret, Ann Thorac Surg 2005;79:2109 –14

Paravertebral Block With Ropivacaine 0.5% Versus Systemic Analgesia for Pain Relief After Thoracotomy

Marret E, Ann Thorac Surg 2005;79:2109 –14

Paravertebral Ropivacaine, 0.3%, and Bupivacaine, 0.25%, Provide SimilarPain Relief After Thoracotomy

Marta García Navlet et al. Journal Cardiothor Vasc Anesth Vol 20, 5 (October), 2006: pp 644-647

A comparison of the analgesic efficacy and side effects of paravertebral versus epidural blockade—A systematic review and meta-analysis of randomized trials.

Davies RG Br J Anaesth 96:418-426, 2006

Bloc Paravertébral

Oui

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 1990;73:840–7.

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 1990;71:625–30.

High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release oftroponin T in patients undergoing coronary artery bypass grafting.

Loick H et al. Anesth Analg 1999;88:701–9.

• 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. 2005;111:2165-2170.

Mortalité Morbidité cardiaque

IDM

PAC 1.7 % 2.4 %

British Cardiac Society, Heart 2003

• Baisse du risque de 1 % 4600 patients

• Méta-analyse. Liu SS, Anesthesiol 2004: 101

15 études, 1178 patients (PAC)

Péri thoracique et chirurgie cardiaque ?

Non

The Use of Epidural Analgesia in Cardiac Surgery Should Be Encouraged

AA, 103(6), December 2006, p 1592

Department of Anesthesiology; Montreal General Hospital; McGill University; Montreal, Canada; HemmerlingDepartment of Anesthesiology; University of Toronto; Ontario, Canada; DjaianiUniversity of Chicago; Chicago, IL; BabbDepartment 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, MDDepartment of Anesthesia and Critical CareUniversity of ChicagoChicago, Illinois

Postoperative Analgesia After Major Spine Surgery:Patient-Controlled Epidural Analgesia VersusPatient-Controlled Intravenous Analgesia

Schenk R, Anesth Analg 2006;103:1311–17

• Ropivacaïne 0.125 % + sufentanil 1 µg/ml

• 14 ml/h, 5 ml, 15 min.

Péri thoracique et neurochirurgie ?

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: 1646–1651

• 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

• H+3: stop Remifentanil

• Objectif: bloc sensitif T2-T12

Péri thoracique et neurochirurgie ?

2 KT valent mieux qu’un.