Placement of coiled catheters into the paravertebral space*

Abstract

SummaryThere are conflicting results with regard to the use of catheter-based techniques for continuous paravertebral block. Local anaesthetic spread within the paravertebral space is limited and the clinical effect is often variable. Discrepancies between needle tip position and final catheter position can also be problematic. The aim of this proof-of-concept study was to assess the reliability of placing a newly developed coiled catheter in human cadavers. Sixty Tuohy needles and coiled catheters were placed under ultrasound guidance, three on each side of the thoracic vertebral column in 10 human cadavers. Computed tomography was used to assess needle tip and catheter tip locations. No catheter was misplaced into the epidural, pleural or prevertebral spaces. The mean (SD) distance between catheter tips and needle tips was 8.2 (4.9) mm. The median (IQR [range]) caudo-cephalad spread of contrast dye injectate through a subset of 20 catheters was 4 (4-5[3-8]) thoracic segments. All catheters were removed without incident. Precise paravertebral catheter placement can be achieved using ultrasound-guided placement of a coiled catheter.

The location of paravertebral catheters placed using the landmark technique

“…The reason could be that most of the studies included involved thoracotomy, where the paravertebral catheter was placed under direct vision by the surgeon. This achieves continuous extrapleural infusion of local anaesthetic solution [16,17], which is conceptually comparable to our cases where the contrast dye was found to lie extra-pleurally. It is intuitively more accurate to place such catheters under direct vision compared to using a landmark-guided, posterior percutaneous approach.…”

“…It is intuitively more accurate to place such catheters under direct vision compared to using a landmark-guided, posterior percutaneous approach. Whether or not it would be possible to improve the observed discrepancy between needle tip position and final catheter tip placement using a different catheter material (for example coiled catheters) remains to be tested in a clinical trial [17].…”

Update on Ultrasound for Truncal Blocks

“…However, these studies used a very strict definition for correct catheter placement, so it is possible that many of the catheters deemed misplaced (epidural, prevertebral, adjacent to the vertebral body, intercostal) could have been effective in a clinical setting. Based on the findings of their anatomic studies, Luyet et al 30 have developed a catheter with a self-coiling tip to help the catheter tip remain close to the needle tip and intended target location. Clinical trials evaluating the effectiveness of this design have not yet been published.…”

Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomy

“…US eşliğinde kateter yerleştirilmesi sırasında iğne ucu rehber alındığı için, klasik sert kateter ucunun son lokalizasyonun öngörülmesi ve görüntülenmesi zordur ve malpozisyon olasılığı sıktır. [18,24] Yumuşak pigtail kateterleri gibi paravertebral alana özel olan yeni geliştirlen kateter coil'ler, iğne ucundan çıktıkları yerde kalırlar ve iğne ucu rehberliğinde yerleştirilmeler için daha kullanışlıdır. [25] Sonuç olarak, torokotomi ağrısının giderilmesinde levobupivakain ve opioid ile devamlı paravertebral veya epidural analjezi uygulaması, benzer etkin analjezi sağladı.…”