Hemodynamic effects of lidocaine in the thoracic paravertebral space during one-lung ventilation for thoracic surgery.

OBJECTIVE There is increasing interest in the use of the thoracic paravertebral block (TPVB) in association with general anesthesia for lung-resection surgery. The aim of the study was to evaluate the hemodynamic effects of a 5-mg/kg lidocaine bolus injected in the thoracic paravertebral space during one-lung ventilation (OLV) in noncardiac patients undergoing thoracic surgery. DESIGN Prospective, observational study. SETTING Tertiary care university hospital. PARTICIPANT Twenty patients undergoing thoracotomy for lung resection. INTERVENTIONS In addition to standard monitoring, cardiac output, preload parameters (global diastolic volume, total intrathoracic blood volume, and systolic volume variation), and myocardial contractility (dP(max) and cardiac function index) were measured with an aortic transpulmonary thermodilution technique. MEASUREMENTS AND MAIN RESULTS After OLV initiation, a paravertebral lidocaine bolus of 5 mg/kg (2%) caused decreases in the dP(max) and cardiac function index that lasted up to 30 minutes. Accompanying minor reductions in heart rate and systolic blood pressure required no vasoactive drugs and were self-limiting. None of the other hemodynamic parameters studied was significantly altered. CONCLUSIONS In noncardiac patients, TPVB is associated with good hemodynamic stability, despite a small and transient decrease in myocardial contractility that could be related to the drug's systemic effects after its absorption.

[1]  Alain Combes,et al.  Estimation of left ventricular systolic function by single transpulmonary thermodilution , 2004, Intensive Care Medicine.

[2]  W. Karzai,et al.  Measuring cardiac output in one-lung ventilation: a comparison of pulmonary artery and transpulmonary aortic measurements in pigs. , 2004, Journal of cardiothoracic and vascular anesthesia.

[3]  Paolo Pietropaoli,et al.  Cardiac output monitoring: aortic transpulmonary thermodilution and pulse contour analysis agree with standard thermodilution methods in patients undergoing lung transplantation , 2003, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[4]  J. Guay,et al.  The number of injections does not influence local anesthetic absorption after paravertebral blockade , 2003, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[5]  M. Casas,et al.  Bilateral paravertebral blockade for conventional cardiac surgery , 2003, Anaesthesia.

[6]  M. G. Costa,et al.  Preload indexes in thoracic anesthesia , 2003, Current opinion in anaesthesiology.

[7]  C. Keyl,et al.  Assessment of intrathoracic blood volume as an indicator of cardiac preload: single transpulmonary thermodilution technique versus assessment of pressure preload parameters derived from a pulmonary artery catheter. , 2001, Journal of cardiothoracic and vascular anesthesia.

[8]  Anthony Rodgers,et al.  Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials , 2000, BMJ : British Medical Journal.

[9]  A. Mearns,et al.  A prospective, randomized comparison of preoperative and continuous balanced epidural or paravertebral bupivacaine on post-thoracotomy pain, pulmonary function and stress responses. , 1999, British journal of anaesthesia.

[10]  J. Richardson,et al.  The Effect of Thoracic Paravertebral Blockade on Intercostal Somatosensory Evoked Potentials , 1998, Anesthesia and analgesia.

[11]  F. Mosteller,et al.  The Comparative Effects of Postoperative Analgesic Therapies on Pulmonary Outcome , 1998 .

[12]  F. Mosteller,et al.  The Comparative Effects of Postoperative Analgesic Therapies on Pulmonary Outcome: Cumulative Meta-Analyses of Randomized, Controlled Trials , 1998, Anesthesia and analgesia.

[13]  P. Lönnqvist,et al.  Paravertebral blockade , 1995, Anaesthesia.

[14]  K. Lindner,et al.  Influence of high thoracic epidural anesthesia on left ventricular contractility assessed using the end‐systolic pressure‐length relationship , 1993, Acta anaesthesiologica Scandinavica.

[15]  J. Ramsay,et al.  EFFECTS OF LIGNOCAINE AND BUPIVACAINE ON REGIONAL MYOCARDIAL FUNCTION AND CORONARY BLOOD FLOW IN ANAESTHETIZED DOGS , 1988 .

[16]  A. Edouard,et al.  Effects of Lidocaine on Myocardial Contractility and Baroreflex Control of Heart Rate in Conscious Dogs , 1986, Anesthesiology.

[17]  M. Wattwil,et al.  Circulatory Changes during High Thoracic Epidural Anaesthesia ‐ Influence of Sympathetic Block and of Systemic Effect of the Local Anaesthetic , 1985, Acta anaesthesiologica Scandinavica.

[18]  M. J. Eason,et al.  Paravertebral thoracic block—a reappraisal , 1979, Anaesthesia.