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Bloc paravertébral échoguidé Arnaud GERMAIN SAR 2/Chirurgie thoracique TUSAR 19/05/2015

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Page 1: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,

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  

Page 12: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,
Page 13: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,
Page 14: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,
Page 15: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,
Page 16: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,
Page 17: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,

Mais,  dans  la  vraie  vie…  

Page 18: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,

Une  efficacité  prévisible??  

Page 19: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,
Page 20: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,
Page 21: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,
Page 22: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,

Conclusion:  

•  Facilité  technique  •  Courbe  d’apprenIssage  rapide  •  Effets  secondaires  et  complicaIons  limités  •  Mais  diffusion  et  efficacité  aléatoire  •  KTPV  >  APD  ?  •  Bonne  soluIon  alternaIve  

Page 23: Bloc%paravertébral%échoguidé%...Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? C. Luyet 1, G. Herrmann2,

MERCI…  


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