[Thoracic Truncal Block : Trends and Future Perspectives].

Abstract

With recent changes in surgical procedures and perioperative management, there has been a growing interest in peripheral nerve blocks of the trunk in patients undergoing thoracic and breast surgery. Tho- racic truncal blocks include paravertebral, pecs, intercostal, and retrolaminar blocks. Previous studies have demonstrated that paravertebral block provides similar analgesic effects and better hemodynamic stability compared with epidural analgesia. In addition, the results of several studies suggest that paravertebral block may improve long-term outcomes such as pre- vention of chronic pain and decrease in recurrence or metastasis after breast cancer surgery. Pecs blocks are novel ultrasound-guided blocks intended to provide analgesia of the anterior chest wall while avoiding seri- ous complications associated with epidural anesthesia and paravertebral block. The novel ultrasound-guided techniques for intercostal nerve blocks have also been reported. Although some case series support that these pecs and intercostal nerve blocks appear to be safe and effective, prospective randomized studies to confirm their clinical usefulness are lacking. Whether to con- duct these thoracic truncal blocks or not will become a standard clinical practice for thoracic and breast sur- gery is yet to be determined.