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Posters • Central Nerve Blocks 51

52. Thoracic paravertebral block versuseneral anesthesia for breast cancerurgery

. Oguz, G. Gulnerman, E. Eskicirak, M. Kaya,

. Kadiogullarinkara Oncology Hospital, Anesthesiology, Ankara,urkey

ackground and Aims: Paravertebral nerve block (PVB) haseen shown in several studies to provide improved pain control forajor breast surgery. We compared thoracic PVB with general

nesthesia (GA) for breast cancer surgery in a single blinded, pro-pective, randomized study.

ethods: 60 patients, were randomized into two groups to receiveither PVB or GA. Both groups had a patient controlled analgesiaevice programmed to deliver a bolus of morphine 2 mg with aockout of 10 min. The primary end-points of the study were tosses postoperative analgesia and the incidence of postoperativeausea and vomiting (PONV). Data were collected by a blindedbserver at 1, 2, 4, 8,12 and 24 hour after patients arrived in theCU.

esults: Five patients in the PVB group had a failed block andequired GA and, therefore, was omitted from the analysis. Sup-lemental local anaesthetic was required in three patients in PVBroup intraoperatively. The median consumption of morphine inhe postoperative 24 h was significantly lower in group PVB com-ared with group GA ( 7 mg [ 0-77 mg ] versus 42 mg [11-100 mg],� 0.05). With regard the postoperative analgesia, of the 25 pa-ients with successful blocks who were available for follow-up, tenequired no analgesics at any time in the postoperative period inhe PVB group. The incidence of postoperative nausea was 20 % inVB group and 86 % in GA group (p� 0.05), and vomiting was 16

and 53 % (p� 0.05) respectively. In PVB group, one patient hadypotension during placement of the block and one had a epiduralpread with bilateral sensorial block at the thoracic level.

onclusion: PVB resulted in a better postoperative pain control,educed opioid consumption and less incidence of PONV comparedo GA.

89. Continuous spinal anesthesia in anchondroplastic dwarf

. Rochaoimbra University Hospital, Anaesthesiology, Coimbra,ortugal

ackground and Aims: Achondroplasia is the most commonorm of short-limbed dwarfism. The incidence is between 0.5-1.5 in0.000 births. This case reports a 31-year-old, 110 cm tall achon-roplastic male dwarf with osteoarthritis scheduled for total hipeplacement under continuous spinal anesthesia (CSA).

ethods: The patient has marked thoracolumbar scoliosis andraniofacial features that preview a difficult airway management.agnetic resonance imaging showed no thoracolumbar spinal ste-

osis and a conus medullaris located at L1 level. After a failedttempt, the epidural space was located at the L3-L4 interspaceith a 18-gauge epidural needle (Crawford’s bevel). The 22-gauge

atheter was advanced intrathecally over the Quincke-type 27-auge spinal needle (Spinocath®, B. Braun, Melsungen, Ger-any). Incremental bolus of 0.5% levobupivacaine was injected

ia the catheter to reach a T10 sensory block. A total of 1.2 ml ofevobupivacaine was administered before surgery and 0.2 ml dur-ng the procedure.

esults: Aside from a short period of mild, asymptomatic hypo-ension, intraoperative and postoperative courses were unremark-ble. Postoperative analgesia was provided by a continuous intra-hecal perfusion of 0,125% levobupivacaine (10ml/24h) by aeriod of 48 hours.

onclusion: Characteristic deformities of achondroplastic dwarfatients can impede management of anesthesia. Available litera-ure supports the feasibility of epidural anesthesia in achondroplas-ic patients for cesarean section. No reports are available about CSAn achondroplastic patients. The decision whether to administeregional anesthesia should be based on an individual risk-to-benefitatio on a case-by-case basis. Careful titration of the local anestheticose is recommended since achondroplastic patients may havextensive spread of subaracnhoid anesthesia.1

ey Words: Continuous spinal anesthesia; achondroplasia.

eference. Regional Anesthesia and Pain Medicine.1997: 102-104.