Indications

PVBs can be utilized to provide anesthesia and analgesia for a variety of procedures (Box 126-1). PVBs provide excellent analgesia after thoracotomy and have unique advantages in patients with anatomic abnormalities, such as kyphoscoliosis and ankylosing spondylitis, in which thoracic epidural placement may be difficult or impossible. PVBs provide better deafferentation than does a thoracic epidural technique, which may help explain why PVBs result in better preservation of pulmonary function, compared with epidural analgesia. There is also evidence that the intensive deafferentation provided by PVBs may attenuate chronic pain and, when used during surgery for resection of (breast) malignancy, may decrease the incidence of metastasis.

PVBs are particularly useful in patients with multiple rib fractures and associated spinal or cranial trauma, in which placement of a thoracic epidural catheter is contraindicated. In these clinical situations, PVBs, especially if a continuous technique is used, obviate the need for systemic analgesia or sedation, which facilitates continuous neurologic assessment.

PVBs have been documented to reverse ischemic cardiac pain and, thus, may provide a treatment option for patients who have had medical and surgical treatment but continue to have ischemic symptoms.

PVBs can be utilized for obstetric analgesia and are particularly useful in situations in which anatomic abnormalities, such as Harrington rods, preclude the use of epidural analgesia.

Contraindications