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. [Copyright &y& Elsevier]