title: The paravertebral lamina technique: a new regional anesthesia approach for breast surgery.
abstract: OBJECTIVE
  To test the feasibility and efficacy of a new approach to paravertebral catheter placement in patients undergoing major surgery of the breast.
  
  
  METHODS
  Single-group, single-center observational study.
  
  
  METHODS
  Operating room, postoperative recovery area, and normal ward of a university hospital.
  
  
  METHODS
  25 ASA physical status 1, 2, 3, and 4 patients undergoing major unilateral surgery of the breast.
  
  
  METHODS
  Paravertebral catheters for intraoperative and postoperative anesthesia and analgesia were applied using the recently described lamina technique. This technique is performed at a more medial puncture site, avoiding the pleura.
  
  
  METHODS
  Additional opioid requirements were recorded to assess effectiveness of regional anesthesia. At the time of catheter withdrawal, patients, staff nurses, and anesthesiologists who provided postoperative pain management were asked to rate their satisfaction with paravertebral catheter effectiveness.
  
  
  RESULTS
  All patients successfully received a paravertebral catheter using the lamina technique. During the surgical procedure, 84% of patients received no additional opioids after intubation. No patient required opioids as rescue medication postoperatively (visual analog scale rating > 30 mm) or during the rest of the hospital stay. Postoperative analgesia provided with paravertebral catheters was rated very high by patients, staff nurses, and anesthesiologists involved in postoperative care.
  
  
  CONCLUSIONS
  The lamina technique for placement of a paravertebral catheter is a feasible and effective technique for intraoperative and postoperative analgesia in patients scheduled for major breast surgery with or without axillary lymph node resection.
authors.affiliation: Department of Anesthesiology, University of Düsseldorf, 40225 Düsseldorf, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Jüttner
authors.forename: Robert
authors.initials: R
authors.lastname: Werdehausen
authors.forename: Henning
authors.initials: H
authors.lastname: Hermanns
authors.forename: Enrico
authors.initials: E
authors.lastname: Monaca
authors.forename: Oliver
authors.initials: O
authors.lastname: Danzeisen
authors.forename: Benedikt H
authors.initials: BH
authors.lastname: Pannen
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Janni
authors.forename: Michael
authors.initials: M
authors.lastname: Winterhalter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000775:Anesthesia, Spinal / Q000379:methods*; D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery; D002404:Catheterization; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D013131:Spine
chemical_list: D000701:Analgesics, Opioid