Yaskevich V.V.*, Marochkov A.V.**
The possibilities of the use of paravertebral blockade on the performance of the sectorial resection of the breast
*Public Health Establishment «Bobruisk Inter-District Oncologic Dispensary», Bobruisk, Republic of Belarus
**Public Health Establishment «Mogilev Regional Hospital», Mogilev, Republic of Belarus
Vestnik VGMU. 2015;14(6):78-83
Objectives. To investigate the efficiency and safety of paravertebral blockade (PVB) for the ensurance of the sectorial resection of the mammary gland depending on the number of blocked cerebrospinal nerves, and the use of small doses of local anesthetics.
Material and methods. The analysis of 21 cases of treatment in 18 women and 3 men was made during the investigation. We performed paravertebral blockade at different levels from Th1 to Th6, under ultrasonic guidance using the «out of plane» techniques. In 4 out of 21 cases we conducted the blockade of the three cerebrospinal nerves at the level of Th3, Th4, Th5. In 15 cases the blockade was performed at 5 levels: Th2, Th3,Th4, Th5, Th6. In 2 cases the blockade was produced at 6 levels: from Th1 to Th6.
Results. The PVB of three cerebrospinal nerves at the levels from Th3 to Th5 during sectorial resection of the breast is obviously insufficient as well as the blockade of five cerebrospinal nerves from Th2 to Th6.
Conclusions. It is necessary to increase the number of blocked nerves up to 3-4 ones located more proximally and 3-4 nerves located more distally than the required level (Th1 – Th7 segments) for using only PVB during minor surgical interventions on the breast. The usage of small volumes and quantities of local anesthetics during PVB provides the safety of anaesthesia in breast surgery. Further study of the possibilities of the application of PVB in the thoracic region is necessary to ensure effective pain relief during breast surgeries.
Key words: paravertebral blockade, sectorial resection, breast.
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