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ESRA19-0499 Paravertebral block as surgical anaesthesia for thoracic surgery in high risk patients: a report of two cases
  1. ZY Beh1,
  2. KWS Ng1,
  3. NH Md Hashim1,
  4. NA Hussain1 and
  5. S Krishnasamy2
  1. 1University of Malaya, Anaesthesiology, Kuala Lumpur, Malaysia
  2. 2University of Malaya, Surgery, Kuala Lumpur, Malaysia


Background and aims Truncal block as primary anaesthetic technique for chest wall surgery is seldom reported. It is usually reserved for patients deemed at high risk for general anaesthesia and surgical procedures are straightforward. According to the literature, paravertebral block (PVB) is the most reliable truncal block for surgical anaesthesia of thoracic wall surgery.

Methods Patients gave written informed consent for case-reporting.

Results Case A was a 42-year-old woman, ASA IV, underwent right video assisted thoracoscopy (VATS) and lung biopsy. She had been investigated for chronic lung disease. She had severe pulmonary hypertension with PASP 70 mmHg, reduced effort tolerance NYHA Class III and metabolic equivalent (MET) less than 4. Her oxygen saturation under room air was 88% and she was taking inhalers of salbutamol, budesonide with anti-failure medication, frusemide and spironolactone. High resolution computed tomography (HRCT) thorax scan showed diffuse ground glass appearance, patchy consolidation, and interlobular septal thickening in all segments of lung.

Case B was a 71-year-old male, ASA IV, underwent right Clagett open-window thoracotomy for empyema thoracis. He had background metastatic renal cell carcinoma (operated). He was frail looking, home-bound with very poor cough effort although his SpO2 under room air was 99%. His CT thorax showed right hydropneumothorax, pleurocutaneous fistula with collection and pleural thickening suggestive of metastasis.

Both cases successfully underwent surgery under PVB, ultrasound-guided intercostal approach, in-plane technique, three-level injections with moderate sedation and went home.

Conclusions These were uncommon cases of successful use of ultrasound-guided PVB as surgical anaesthesia for high-risk patients underwent thoracic wall surgeries.

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