title: Supraclavicular and paravertebral blocks: Are we underutilizing these regional techniques in perioperative analgesia?
abstract: There has been a renewed interest in supraclavicular and paravertebral blocks for regional anesthesia. Studies have shown a high block success rate with the supraclavicular approach to the brachial plexus. Despite the use of ultrasound, pleural puncture and pneumothorax may still occur. The supraclavicular block is associated with a higher incidence of phrenic nerve paralysis and caution should be exercised in patients with respiratory difficulties. Paravertebral blocks have been used successfully to provide analgesia and anesthesia for a variety of surgical procedures. When compared to thoracic epidural blockade for thoracic surgery, paravertebral blockade provides comparable analgesia with a better preservation of pulmonary function and a lower incidence of hypotension. This brings forth the question as to whether paravertebral blocks have replaced epidural blockade as the gold standard in perioperative pain management for thoracoabdominal procedures.
authors.affiliation: Department of Anesthesiology, LSUHSC-Shreveport, Shreveport, LA, USA. Electronic address: vkoyya@lsuhsc.edu.
authors.forename: Veerandra B
authors.initials: VB
authors.lastname: Koyyalamudi
authors.affiliation: Department of Anesthesiology, LSUHSC-Shreveport, Shreveport, LA, USA. Electronic address: sarulk@lsuhsc.edu.
authors.forename: Sailesh
authors.initials: S
authors.lastname: Arulkumar
authors.affiliation: Department of Anesthesiology, LSUHSC-Shreveport, Shreveport, LA, USA. Electronic address: byost@lsuhsc.edu.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Yost
authors.affiliation: Department of Anesthesiology, LSUHSC-Shreveport, Shreveport, LA, USA. Electronic address: cfox1@lsuhsc.edu.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Fox
authors.affiliation: Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA. Electronic address: rurman@partners.org.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
authors.affiliation: Louisiana State University School of Medicine, New Orleans, LA, USA. Electronic address: alankaye44@hotmail.com.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Kaye
mesh_terms: D000698:Analgesia / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D001917:Brachial Plexus / Q000000981:diagnostic imaging; D002968:Clavicle / Q000000981:diagnostic imaging; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D059408:Pain Management; D010149:Postoperative Pain; D019990:Perioperative Care; D012782:Shoulder / Q000601:surgery; D018084:Ultrasonography, Interventional
keywords: paravertebral block; perioperative pain; regional anesthesia; supraclavicular block; thoracic epidural; ultrasound