ESRA Academy. Kalava A. Sep 8, 2016; 138371; 0211 Topic: MISCELLANEOUS
Dr. Arun Kalava
Dr. Arun Kalava

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Background and Aims:

Thoracic outlet syndrome (TOS) rarely requires surgery and postoperative pain is managed with opioids either on an on needed basis or as patient controlled analgesia (PCA).  We report the use of T 1, T 2 paravertebral nerve blocks (PVBs) for post- operative analgesia after first fib resection for thoracic outlet syndrome (TOS).



After informed consent, PVBs were performed using the traditional landmark technique in 3 different patients.  The C7 spinous process (most prominent) and T 1 were identified using palpation. A 5 mL injectate of 1% ropivacaine was then deposited in the paravertebral space after confirmation of no aspiration to blood and no paresthesias.  The success of the block was confirmed using loss of temperature sensation to ice in the corresponding dermatomes i.e., T 1 and T2.

Post operatively patients were placed on IV hydromorphone PCA and pain scores were recorded frequently and the amount of hydromorphone consumed in 24 hours was assessed.



Of the 3 patients observed, one had bilateral 1st rib resections each performed at separate time periods allowing us to analyze a total of 4 blocks and their efficacy in managing postoperative pain after surgery.  Total hydromorphone consumption was 2 mg or less in the first 24 hours among all 4 observed surgeries and patients reported very good pain relief.


T1 and T2 PVBs seem a good analgesic option in patients undergoing 1st rib resection for neurogenic TOS.

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