Paravertebral block is not safer nor superior to thoracic epidural analgesia
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Gísli Vigfusson
Dear Editor,
I read with interest the review by Norum and Breivik [1] as well as the editorial comment by Niemi and Breivik [2] on paravertebral blocks (PVB) in the first issue of 2010 of the Scandinavian Journal of Pain. I would like to emphasize the warnings in both of these papers about possible severe and serious complications to PVB. PVB has been a standard technique in breast cancer surgery in our department the last 15 years. This technique was introduced by Bjarni Valtýsson and it seems very easy to perform. But even though it was technically easy to apply, we experienced serious complications that came as big surprises to us. In the first years we had one high spinal, one epidural with Horner’s syndrome, one pneumothorax, and one intravenous injection. All these complications were handled successfully by experienced anaesthesiologists and had no serious sequelae.
More serious was what happened three years ago: one of our experienced epidural-anaesthesiologists caused a high spinal anaesthesia after attempted paravertibral block. After recovery from the block, the patient had a flaccid arm and radiating pain into the arm. MRI showed a lesion in the thoracic segment of the spinal cord, corresponding to where the needle was put in.
Thus, we have to emphasize that paravertebral block looks like it is easy to perform, but our experience tells us that PVB can cause dramatic and tragic complications, and that PVB is not a safer technique, at all, than a thoracic epidural block. It therefore worries us that numerous, uncritically enthusiastic publications keep on stating that paravertebral block is so easy to perform, and so safe that even monitoring can be omitted. Several of these were rightfully criticized by Norum and Breivik in their review paper (2010).
References
[1] Norum H, Breivik H. A systematic review of comparative studies indicates that paravertebral block is neither superior nor safer than epidural analgesia for pain after thoracotomy. Scand J Pain 2010;1:12–23.Search in Google Scholar
[2] Niemi G, Breivik H. Pain relief with paravertebral blocks or epidural analgesia? Those who do not know the history of paravertebral blocks are condemned to rediscover the complications. Scand J Pain 2010;1:3–4.Search in Google Scholar
© 2010 Scandinavian Association for the Study of Pain
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- Editorial comment
- Neuroinflammation explains aspects of chronic pain and opens new avenues for therapeutic interventions
- Review
- Long-term pain, neuroinflammation and glial activation
- Editorial comment
- Long-term pain and disturbed sensation after plastic surgery
- Original experimental
- Hyperesthesia one year after breast augmentation surgery increases the odds for persisting pain at four years A prospective four-year follow-up study
- Editorial comment
- Trismus—An important issue in pain and palliative care
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