1. Bloc paravertébral
Eason MJ, Wyatt R: Paravertebral thoracic block-a reappraisal. Anaesthesia 1979; 34:638–42

2. Thoracic Paravertebral Block
Manoj K. Karmakar Anesthesiology 2001; 95:771–80

5. Marret, Ann Thorac Surg 2005;79:2109 –14

6. Paravertebral Block With Ropivacaine 0
Paravertebral Block With Ropivacaine 0.5% Versus Systemic Analgesia for Pain Relief After Thoracotomy
Marret E, Ann Thorac Surg 2005;79:2109 –14

7. Pain Relief After Thoracotomy
Paravertebral Ropivacaine, 0.3%, and Bupivacaine, 0.25%, Provide Similar
Pain Relief After Thoracotomy
Marta García Navlet et al. Journal Cardiothor Vasc Anesth Vol 20, 5 (October), 2006: pp

8. A comparison of the analgesic efficacy and side effects of paravertebral versus epidural blockade—A systematic review and meta-analysis of randomized trials.
Davies RG Br J Anaesth 96: , 2006

9. Bloc Paravertébral
Oui

10. Péri thoracique et chirurgie cardiaque ?
Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease.
Blomberg S et al. Anaesthesiol 1990;73:840–7.
Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease. Kock M, Blomberg S et al. Anesth Analg 1990;71:625–30.
High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of
troponin T in patients undergoing coronary artery bypass grafting.
Loick H et al. Anesth Analg 1999;88:701–9.

11. Effets anti-ischémiques Amélioration de la fonction diastolique
Sympatholyse
Baisse de la VO2
Effets anti-ischémiques
Amélioration de la fonction diastolique
« In patients with multivessel ischemic heart disease, TEA partly normalizes the myocardial blood flow in response to sympathetic stimulation. »
Nygård E et al. Circulation. 2005;111:

12. Baisse du risque de 1 % 4600 patients
Mortalité
Morbidité cardiaque
IDM
PAC
1.7 %
2.4 %
British Cardiac Society, Heart 2003
Baisse du risque de 1 % patients

13. Méta-analyse. Liu SS, Anesthesiol 2004: 101
15 études, 1178 patients (PAC)

14. Péri thoracique et chirurgie cardiaque ?
Non

15. The Use of Epidural Analgesia in Cardiac Surgery Should Be Encouraged
AA, 103(6), December 2006, p 1592
The Use of Epidural Analgesia in Cardiac Surgery Should Be Encouraged
Department of Anesthesiology; Montreal General Hospital;
McGill University; Montreal, Canada; Hemmerling
Department of Anesthesiology; University of Toronto; Ontario, Canada; Djaiani
University of Chicago; Chicago, IL; Babb
Department of Anesthesiology; University of Pittsburgh; Pittsburgh, PA; Williams
For patients undergoing cardiac surgery, anesthesiologists should choose analgesic options that focus more on minimizing risk than maximizing the potential of unproven benefits.
Mark A. Chaney, MD
Department of Anesthesia and Critical Care
University of Chicago
Chicago, Illinois

16. Péri thoracique et neurochirurgie ?
Postoperative Analgesia After Major Spine Surgery: Patient-Controlled Epidural Analgesia Versus Patient-Controlled Intravenous Analgesia Schenk R, Anesth Analg 2006;103:1311–17
Ropivacaïne % + sufentanil 1 µg/ml
14 ml/h, 5 ml, 15 min.

17. Postoperative Analgesia After Anterior Correction of
Thoracic Scoliosis: A Prospective Randomized Study , Comparing Continuous Double Epidural Catheter Technique With Intravenous Morphine.
Blumenthal S, SPINE 2006; 31, 15: 1646–1651
2 KT perop, voie antérieure transforaminale (T4-5, T10-12)
J0: Remifentanil
J1 à 8H: Ropivacaïne 0.3 % 4-8 ml dans chaque KT, puis 4-10 ml/h
H+3: stop Remifentanil
Objectif: bloc sensitif T2-T12

20. Péri thoracique et neurochirurgie ?
2 KT valent mieux qu’un.