Anesth Analg 2007;104:207-208
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000247691.77689.58
LETTER TO THE EDITOR
Editor-in-Chief Steven L. Shafer
Paravertebral Block: The Holy Grail of Anesthesia for Hernia Surgery?
Admir Hadzic, MD,
Kerimoglu Beklen, MD,
P. E. Karaca, MD, and
R. E. Claudio, BS
Department of Anesthesiology, St. Luke’s-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, New York, admir{at}nysora.com
In Response:
We agree with many of the comments of Dr. Baumgarten et al. (1), but we do not agree that a nerve stimulator-assisted technique for paravertebral block (2) has become the new standard. Although this technique has been described (3–7), the reports all stem from a single research group. Our experience is that electrical stimulation is nonspecific, requires more needle insertions and results in greater patient discomfort than the similarly effective traditional technique of walking off the transverse process (2,8,9).
We did not intend to suggest that paravertebral block should be the standard technique for all patients having inguinal hernia repair, as implied by the accompanying editorial (10). Paravertebral block is an advanced regional anesthesia procedure that requires considerable skill and training for its successful implementation. Our findings simply indicate that paravertebral block is a highly specific and effective anesthetic option that may offer multiple benefits over general anesthesia.
REFERENCES
- Baumgarten RK, Greengrass RA, Wesen CA. Paravertebral block: the holy grail of anesthesia for hernia surgery? Anesth Analg 2007;104:207.[Free Full Text]
- Hadzic A, Kerimoglu B, Loreio D, et al. Paravertebral blocks provide superior same-day recovery over general anesthesia for patients undergoing inguinal hernia repair. Anesth Analg 2006;102:1076–81.[Abstract/Free Full Text]
- Naja MZ, El Hassan MJ, Oweidat M, et al. Paravertebral blockade versus general anesthesia or spinal anesthesia for inguinal hernia repair. Middle East J Anesthesiol 2001;16:201–10.[Medline]
- Naja Z, Ziade MF, Lonnqvist PA. Bilateral paravertebral somatic nerve block for ventral hernia repair. Eur J Anaesthesiol 2002;19:197–202.[ISI][Medline]
- Naja MZ, Ziade MF, Lonnqvist PA. General anaesthesia combined with bilateral paravertebral blockade (T5–6) versus general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial. Eur J Anaesthesiol 2004;21:489–95.[ISI][Medline]
- Naja MZ, Ziade MF, Lonnqvist PA. Nerve-stimulator guided paravertebral blockade versus general anaesthesia for breast surgery: a prospective randomized trial. Eur J Anaesthesiol 2003;20:897–903.[ISI][Medline]
- Naja ZM, Raf M, El Rajab M, et al. Nerve stimulator-guided paravertebral blockade combined with sevoflurane sedation versus general anesthesia with systemic analgesia for postherniorrhaphy pain relief in children: a prospective randomized trial. Anesthesiology 2005;103:600–5.[ISI][Medline]
- Klein SM, Pietrobon R, Nielsen KC, et al. Paravertebral somatic nerve block compared with peripheral nerve blocks for outpatient inguinal herniorrhaphy. Reg Anesth Pain Med 2002;27:476–80.[ISI][Medline]
- Greengrass R, Buckenmaier CC III. Paravertebral anaesthesia/analgesia for ambulatory surgery. Best Pract Res Clin Anaesthesiol 2002;16:271–83.[Medline]
- White PF. Choice of peripheral nerve block for inguinal herniorrhaphy: is better the enemy of good? Anesth Analg 2006;102:1073–5.[Free Full Text]
