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What is Thoracic Block?
The thoracic paravertebral block involves injecting local
anesthetic in the area of the thoracic spinal nerves
emerging from the intervertebral foramen with the resultant
ipsilateral somatic and sympathetic nerve blockade.
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Effects of Thoracic Block
The thoracic block results in ipsilateral somatic and
sympathetic nerve blockade in multiple contiguous thoracic
dermatomes above and below the site of injection.
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Candidates for Thoracic Block
This block is ideal for surgery in patients undergoing
breast (mastectomy and cosmetic breast surgery) and thoracic
surgery.
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Your
Consultation
Prior to the actual procedure, the doctor will evaluate the
patient and explain the procedure in detail, including
possible complications and side effects. The doctor will
also answer any questions that the patient may have. The
patient should inform the doctor of his drug allergies,
medications he is taking, medical conditions and any
previous reactions to anesthesia.
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The Thoracic Block
Procedure
The patient is positioned in the sitting or lateral
position and then the skin surrounding the injection site
will be cleansed with an antiseptic solution. The injection
should be carried out slowly to minimize pain. Any new
needle reinsertions should be made through already
anesthetized skin.
The
needle is then inserted perpendicular to the skin, while
constantly paying attention to the depth of needle insertion
and the medial-lateral needle orientation. It is essential
that utmost care should be paid to avoid medial needle
direction. After the transverse process is contacted, the
needle is withdrawn to the skin and redirected superior or
inferior to walk off the transverse process. The main goal
is to insert the needle to a depth of 1 cm. past the
trans-verse process. A certain "give" occasional can be felt
as the needle passes through the costotransverse ligament,
however, this is non-specific and should not be relied on.
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Recovery
After the procedure, the patient may continue to take his regular
pain medicine, with the exception of limiting pain medicine
within the first 4 to 6 hours after injection so that the
diagnostic information obtained is accurate. The patient may
be referred for physical therapy or manual therapy after the
injection while the numbing medicine is effective and/or
over the next several weeks while the cortisone is working.
The patient may resume regular activities on the next day. It is
also advisable to start regular exercise and activities in
moderation once the pain has improved. Even if the pain
relief is significant, it is still important to gradually
increase activities over 1 to 2 weeks to avoid recurrence of
pain.
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Risks
Some
complications to this procedure include infection, hematoma,
local anesthetic toxicity, nerve injury, total spinal
anesthesia, quadriceps muscle weakness and paravertebral
muscle pain.
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Frequently Asked
Questions
Q:
What is the purpose of a thoracic block?
A: The goal of thoracic block is not just to block noxious
afferent stimuli from the surgical site, but also
to impart a bilateral selective thoracic sympathectomy.
Provision of pain relief and sympatholysis of such
magnitude that allows patients to cough, breath
deeply, drink and mobilize can contribute to
enhanced post-operative results.
Q:
What are the benefits of this procedure?
A:
A single injection produces multi-dermatomal ipsilateral somatic and
sympathetic nerve block. It also maintains hemodynamic
stability and reduces opioid requirements. There is also a
low incidence of complications. Thoracic block preserves
bladder sensation, lower limb motor power and also promotes
early mobilization.
Q:
What should I do on the day of the procedure?
A:
On
the day of the injection, the patient is advised to avoid
performing any strenuous activities, unless instructed by
their physician. The patient should not drive unless
approved by the treating physician. If sedation was used,
the patient should not drive for at least 24 hours after the
procedure.
Q: Will
it hurt?
A:
The patient may notice a slight increase in pain lasting for
several days as the numbing medicine wears off and before
the cortisone starts to take effect. If the area is
uncomfortable in the first 2 to 3 days after the injection,
carefully apply ice or a cold pack to the injection site to
provide pain relief.
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