ABSTRACT
BACKGROUND: The objective of this review was to assess the safety and efficacy of thoracic and lumbar paravertebral blocks (PVBs) for surgical anesthesia through a systematic review of the peer-reviewed literature. PVBs for surgical anesthesia were compared with general anesthesia (GA) or other regional anesthetic techniques. METHODS: We searched literature databases including MEDLINE, EMBASE, and The Cochrane Library up to May 2008. Included studies were limited to eligible randomized controlled trials. Eight randomized controlled trials were included in this review, 6 of which used PVBs for anesthesia during breast surgery, and 2 trials used PVB for anesthesia during herniorrhaphy. RESULTS: The ability to obtain firm conclusions was limited by the diversity of outcomes and how they were measured, which varied across studies. The PVB failure rate was not >13%, and patients were more satisfied with PVB than with GA. There was some indication that PVB could achieve shorter hospital stays than GA. PVB for anesthesia substantially reduces nausea and vomiting in comparison with GA (relative risk: 0.25, 95% CI: 0.13-0.50; P < 0.05), although it does carry a risk of pleural puncture and epidural spread of local anesthetic. CONCLUSIONS: In conclusion, based on the current evidence, PVBs for surgical anesthesia at the level of the thoracic and lumbar vertebrae are associated with less pain during the immediate postoperative period, as well as less postoperative nausea and vomiting, and greater patient satisfaction compared with GA.
Subject(s)
Anesthesia, Spinal , Nerve Block , Anesthesia, General , Anesthesia, Spinal/adverse effects , Anesthesia, Spinal/mortality , Humans , Length of Stay , Lumbar Vertebrae , Nerve Block/adverse effects , Nerve Block/mortality , Pain, Postoperative/epidemiology , Patient Satisfaction , Postoperative Complications/epidemiology , Postoperative Nausea and Vomiting/epidemiology , Randomized Controlled Trials as Topic , Surgical Procedures, Operative , Thoracic Vertebrae , Treatment FailureABSTRACT
Background and objectives - This study was intended to evaluate the ability of medical students to identify the occurrence of clinical problems or complications during their training periods in anesthesia. Methods - Three groups of undergraduate students from two medical schools were evaluated. Groups I and II were composed by students of the University of Witwatersrand, South Africa, who were attending their 9th and 10th semesters respectively. Group III was formed by students of the Universidade Federal do Rio Grande do Sul, Brazil, in their 10th and 11th semesters. The three groups received introductory classes in anesthesia during their fourth year of medical school. Later, during their internship program, only Group II students received formal classes which included topics on anesthetic complications. A standard repor form was distributed to the students in the first day and collected in the last day of theirtraining period. The students were supposed to register: a) type and number of anesthetics observed; b) clinical problems and complications occurring during the anesthetic procedures and in the pospoerative period; c) management of these occurrences and the physical status of the patient. Results - Ninety-two percent of the students in Group I, 100 per cent in Group II and 88 per cent in Group III returned the forms. There was a predominance of observation of general anesthetics in all groups, specially in group II. Respiratory and cardiovascular problems reported by the three groups prevailed in the perioperative period. Group II students demonstrated a better understanding of the causes of complications and their mamagement. Conclusions - The results of this enquiry suggest that the teaching of anesthesia for undergraduate students, oriented to the recognition of clinical problems in the perioperative period, provides the medical students with important clinical information, usually not available in other teaching prgrams
