Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement...
Transcript of Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement...
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Bloc paravertébral échoguidé
Arnaud GERMAIN SAR 2/Chirurgie thoracique
TUSAR 19/05/2015
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INDICATIONS
• Chirurgie thoracique • Chirurgie mammaire • TraumaIsme thoracique • Douleurs chroniques • Zona intercostal • Hyperhydrose palmaire
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Contre-‐indicaIons/ ComplicaIons
• CI: – Celles de l’ALR – Perte d’intégrité pleurale
• ComplicaIons: – PoncIon pleurale (<1%) – Effets secondaires du bloc sympathique
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ANATOMIE
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TECHNIQUE DE POSE
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REPERES ECHOGRAPHIQUES
Apophyse transverse
Plèvre
Lgt costo-‐vertébral
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REPERES ECHOGRAPHIQUES
Espace para-vertébral
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Recul de la plèvre
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Diffusion à plusieurs espaces
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INTERÊT ?
KT PV= APD unilatérale…
…En mieux?
Davies RG. Br J Anaesth 2006
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Efficacité/Effets secondaires
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Mais, dans la vraie vie…
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Une efficacité prévisible??
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Conclusion:
• Facilité technique • Courbe d’apprenIssage rapide • Effets secondaires et complicaIons limités • Mais diffusion et efficacité aléatoire • KTPV > APD ? • Bonne soluIon alternaIve
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MERCI…