POSTOPERATIVE PARA VERTEBRAL BLOCKS FOR THORACIC SURGERY A Radiological Appraisal I. D. CONACHER AND M. KOKRI
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چکیده
Intercostal nerve blockade is a useful adjuvant technique for the relief of pain after thoracic operations (Moore, 1975). However, a series of blocks may be necessary to produce adequate analgesia of the skin. Prolongation of the duration of analgesia can be achieved with catheter techniques, and a system in which a single catheter is utilized would be a useful addition to the armamentarium of the thoracic anaesthetist since it would lend itself to continuous infusions of the kind used in association with extradural blockade (Conacher et al., 1983). Several studies on cadavers (Nunn and Slavin, 1980; Moore, 1981) have demonstrated that the anatomical plane in which the intercostal nerve lies is contiguous with that above and below. This explains why an injection in one intercostal space may result in analgesia over several dermatomes. Medial spread of drug from the intercostal space is also likely, as far as the extradural space according to some reports (Mclntosh and Mushin, 1947; Middaugh et al., 1985). In 1979, Eason and Wyatt revitalized interest in the paravertebral space as a repository for catheters and local anaesthetic, and described the widespread, unilateral analgesia which could be achieved by the use of two catheters. Using the same approach, we have inserted a single catheter to a series of patients following a thoracic operation; in some, contrast medium was injected through the catheter.
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تاریخ انتشار 2005