The location of paravertebral catheters placed using the landmark technique

Abstract

SummaryThe aim of this prospective clinical study was to evaluate the location of paravertebral catheters that were placed using the classical landmark puncture technique and to correlate the distribution of contrast dye injected through the catheters with the extent of somatic block. Paravertebral catheter placement was attempted in 31 patients after video-assisted thoracic surgery. In one patient, an ultrasound-guided approach was chosen after failed catheter placement using the landmark method. A fluoroscopic examination in two planes using contrast dye was followed by injection of local anaesthetic and subsequent clinical testing of the extent of the anaesthetised area. In nine patients (29%), spread of contrast dye was not seen within the paravertebral space as intended. Misplaced catheters were in the epidural space (three patients), in the erector spinae musculature (five patients), and in the pleural space (one patient). There was also a discrepancy between the radiological findings and the observed distribution of loss of sensation. We have demonstrated an unacceptably high misplacement rate of paravertebral catheters using the landmark method. Additional research is required to compare the efficacy and safety of continuous paravertebral block using ultrasound-guided techniques or surgical inserted catheters.

Ocena porównawcza skuteczności ciągłego znieczulenia zewnątrzoponowego i ciągłego znieczulenia przykręgowego w analgezji pooperacyjnej po wideotorakoskopowych resekcjach płata płuca

“…A single injection technique can be fully controlled, yet the continuous block may be unstable. Despite the methods of visualisation or identification of the spinal nerve that can be applied, the major issue is the final location of catheters in relation to the endothoracic fascia and parietal pleura [6,13]. The surgical method of catheter insertion into the paravertebral space under the parietal pleura with fenestration of the endothoracic fascia is preferable in some centres [16].…”

ANAESTHESIOLOGY AND INTENSIVE CARE The efficacy of thoracic epidural and paravertebral blocks for post-thoracotomy pain management

“…Additional research is required to compare the efficacy and safety of continuous paravertebral block using ultrasound-guided techniques or surgical inserted catheters [20]. This mode of analgesia is not considered to be a stand alone technique (in contrast to epidural analgesia) and most patients will require additional analgesia (usually parenteral patient controlled analgesia).…”

The Judas needle

“…There are no warnings of these incompatibilities in the product literature for the B.Braun syringes [1], nor could we find any common excipient in the summary of product characteristics sheets for prochlorperizine [2] or diclofenac [3] that could have caused a reaction with the polypropylene syringe. The only discernible difference between the two syringes is the addition of a polyisoprene plunger stopper in the three-piece Omnifix syringe and the absence of silicone in the two-piece Injekt syringe.…”

“…I agree that there is a need for studies comparing ultrasound with landmark approaches. Manufacturers' obligations to colour-code prefilled syringes correctly I read with interest the letter from by Dr Torlot [1]. The debate surrounding drug-label colour-coding in anaesthesia has been active for around 30 years, much of it taking place in this journal [2][3][4].…”

“…In correspondence, Baxter Healthcare have recommended that a vented administration set be used when venting of a rigid container is The safety of paravertebral nerve block Luyet et al [1] found a 26% clinical failure rate with paravertebral catheter insertion using a landmark technique. Shelley and Macfie were therefore correct to question the risk/ benefit ratio of paravertebral catheters [2], particularly when compared with epidural block, and especially in relation to thoracic anaesthesia.…”