Features of the development of thoracic paravertebral blockade as a component of anesthesia in radical mastectomy

The aim of this work is the study of thoracic paravertebral blockade (PVB) in different anatomical parts of the chest. The usage of the PVB for 31 women was analysed. PVB was performed at the levels of Th1, Th2, Th3, Th4, Th5 and Th6, under ultrasound guidance. 1.5 ml of local anesthetic (0,75% solution of ropivacaine) was introduced on each level. The borders of altered pain sensitivity was evaluated using "pin prick" at the notional vertical lines of the chest (paravertebral, scapular, posterior axillary, mid-axillary, midclavicular and sternal). The obtained distances were measured by centimeter ruler. After blockade of spinal nerves from Th1 through Th6, the extent of the blockade of the pain sensitivity was reveded: paravertebral line at 21.7±3.9 cm, along the scapular line is a distance of 19.1±3.6 cm, on posterior axillary line of 14.5±2.6 cm, on an mid-axillary line - of 14.9±3.3 cm on the midclavicular line is 11.9±4.2 cm, sternal line - 5.4±3,3 cm. The decrease in the severity of the blockade on pain sensitivity in the midclavicular line from central to peripheral anatomical areas was observed. 71% of patients on the first day after surgery was not required additional analgesia, in 16% of cases the period of analgesia ranged from 6 to 18 hours. The decrease of the size of analgesia takeplace surface when moving from the spine to the sternum that can significantly affect the quality of anesthesia during operations on the thorax. PVB intercostal nerve Th1-Th6 with small doses of local anesthetic anesthetic is effective in ensuring operations in the amount of radical mastectomy.

paravertebral block, breast cancer, mastectomy, small doses of local anestetics