Paravertebral blockade as indication, not as anesthesia choice - two case reports

Background and purpose. We present two case reports of patients with ASA IV status, scheduled for surgery due to a malignant process. They were contraindicated for general anesthesia so we decided to perform paravertebral blockade. Patients and Methods: Case 1. A 84-year-old female patient was scheduled for operation because of a malignant process in the left axillary region. She was an ASA IV patient with a suspected malignant process in the lung, bilateral tumor of suprarenal glands, hypothyreosis, and chronic renal insufficiency. Chest X-ray showed decompensated heart. Case 2. A 69-year-old male patient was scheduled for operation of malignant melanoma on the back. He was an ASA IV patient with implanted cardiac electrostimulator liver cirrhosis, and obstructive lung disease. Chest X-ray showed decompensated heart. Paravertebral space was identified with ultrasound using 8 Hz linear transducer probe. Additionally, needle position was confirmed with neurostimulation. When muscle contraction persisted at 0.4 mA, an anesthetic was applied in levels of Th1, Th2, and Th3 (5 ml per level); in first case, a mixture of 7.5 ml 0.5% levobupivacaine [Chirocaine (R), Abbott Laboratories] and 7.5 ml 2% lydocain[Lidocaine (R), Belupo], and in second case, 15 ml 0.5% levobupivacaine. Results: Sensory blockade occurred after 15 minutes in the first case, and after 20 minutes in the second case. The surgery was without complications. In the first case, sensory blockade lasted for 4.5 h after block was administered, which is 3h after surgery, and 12 h after blockade or 10 h after surgery in the second case. Conclusion: At 24h postoperative interview, both patients were very satisfied with the anesthesiology treatment, and no complications occurred.