Varying anatomical injection points within the thoracic paravertebral space: effect on spread of solution and nerve blockade

Naja, M. Z.; Ziade, Fouad; Rajab, Mariam; Tayara, Khalil; Lönnqvist, Per‐Arne

doi:10.1111/j.1365-2044.2004.03705.x

Cited by 106 publications

(76 citation statements)

References 20 publications

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“…1,13,14,[21][22][23] Of interest, Cowie recently showed that more solution covers a greater number of intercostal segments with an in-plane lateral to medial ultrasound guided-approach when compared with the paravertebral segments. 1 Additionally, spread of solution was greater in terms of distance from the injection site in the intercostal space when compared with the paravertebral space.…”

Section: Discussionmentioning

confidence: 99%

“…1,11 Analgesia and spread of local anesthetic can be inconsistent, and success rates are typically reported to be less than 90%. [12][13][14] The traditional ''blind'' approach to the paravertebral space involves tactile identification of a transverse process with the tip of the block needle and then ''walking the needle off'' in either the cephalad or caudad direction about 1 cm deeper or until a ''pop'' is felt penetrating through the costotransverse ligament (Fig. 1).…”

Section: Techniquementioning

confidence: 99%

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The ultrasound-guided retrolaminar block

Voscopoulos

Palaniappan

Zeballos

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Paravertebral blocks have gained in popularity and offer the possible benefit of reduced adverse effects when compared with epidural analgesia. Nevertheless, pulmonary complications in the form of inadvertent pleural puncture are still a recognized risk. Also, the traditional paravertebral blocks are often technically difficult even with ultrasound guidance and constitute deep noncompressible area injections. We present our experience with the first three patients receiving ultrasound-guided retrolaminar blocks for managing the pain associated with multiple rib fractures. Clinical features The vertebral laminae are identified by ultrasound imaging in a paramedian sagittal plane by sequentially visualizing the pleura and ribs, transverse processes, and the corresponding laminae (from lateral to medial). The block needle is guided to contact the lamina, and the local anesthetic injectate is visualized under real-time imaging. A catheter is inserted and used for continuous analgesia. In three consecutive patients, verbal rating scale (VRS) pain scores were reduced from 10/10 to less than 5/10, and no technical difficulties, complications, or adverse effects were encountered. Conclusions Successful analgesia was achieved in all three cases utilizing continuous infusion and intermittent boluses with ultrasound-guided retrolaminar blocks. These results show the feasibility of this approach for patients with multiple rib fractures. RésuméObjectif Les blocs paravertébraux ont gagné en popularité et offrent l'avantage de réduire potentiellement les effets secondaires comparativement à l'analgésie péridurale. Toutefois, les complications pulmonaires, sous forme de ponction pleurale involontaire, demeurent un risque bien connu. En outre, les blocs paravertébraux conventionnels sont souvent difficiles à réaliser d'un point de vue technique et ce, même sous échoguidage, étant donné qu'il s'agit d'injections profondes réalisées dans des zones non compressibles. Nous rapportons notre expérience auprès des trois premiers patients à recevoir un bloc rétrolaminaire échoguidé pour la prise en charge de la douleur associée à une fracture multiple des cô tes. É léments cliniques Les lames vertébrales sont identifiées par ultrason dans un plan sagittal paramédian en visualisant la plèvre et les cô tes, les apophyses transverses, et les lames correspondantes (des lames latérales aux médiales) séquentiellement. L'aiguille du bloc est guidée jusqu'à ce qu'elle atteigne la lame, et l'anesthésique local injecté est visualisé par imagerie en temps réel. Un cathéter est inséré et utilisé pour l'analgésie en continu. Chez trois patients consécutifs, les scores de douleur sur une échelle visuelle ont baissé de 10/10 à Author contributions Christopher Voscopoulos, Dhamodaran Palaniappan, Jose Zeballos, Kamen Vlassakov, and Hanjo Ko performed blocks. Christopher Voscopoulos, Dhamodaran Palaniappan, Jose Zeballos, Kamen Vlassakov, Hanjo Ko, Michael Kapottos, David Janfaza, and Agnieszka Trzcinka contributed to writing the paper. ...

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Section: Discussionmentioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

The ultrasound-guided retrolaminar block

Voscopoulos

Palaniappan

Zeballos

et al. 2013

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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“…It is well documented that with a multi-level single injection paravertebral technique, unilateral anaesthesia of the thorax can be achieved with a high success rate, irrespective whether a landmark-based technique [4,5,14,15] or an ultrasound-guided approach [8] has been chosen. There is, however, some controversy surrounding the use of catheters for continuous paravertebral block because of limited cranio-caudal spread of local anaesthetic [16] as well as the possible discrepancy between the needle tip position and the final catheter tip location [12].…”

Section: Discussionmentioning

confidence: 99%

The location of paravertebral catheters placed using the landmark technique

Luyet¹,

Siegenthaler²,

Szücs-Farkas

et al. 2012

Anaesthesia

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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.

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“…Paravertebral blok uygulamalarında 0.36 ml/kg enjekte edilen lokal anesteziğin vertikal düzlemde en az dört segment yayılımının olduğu gösterilmiştir. [3,4] Ancak kişi- sel anatomik farklılıklar, blok uygulanan seviye, lokal anesteziğin volümü tek enjeksiyon ile lokal anesteziğin vertikal eksende eşit dağılmasını engelleyebilir. [3,5] Çoklu enjeksiyon ile muhtemelen lokal anesteziğin birden fazla seviyeye ilaç dağılımı daha iyi sağlanır.…”

Section: Discussionunclassified

Our ultrasound guided paravertebral block experiences in thoracic surgery

Kuş

Gürkan

Arslan

et al. 2015

Agri

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ÖzetAmaç: Torasik cerrahide ameliyat sonrası analjezi amacıyla ultrason rehberliğinde torasik paravertebral blok (TPVB) tercih edilebilmektedir. Torasik paravertebral blok uygulamalarında tekli, çoklu enjeksiyon veya kateter teknikleri kullanılabilir. Yazımızda toraks cerrahisi geçiren hastalara ameliyat sonrası analjezi amacıyla uyguladığımız ultrason rehberliğindeki TPVB deneyimlerimizi paylaşmayı amaçladık. Gereç ve Yöntem: Kliniğimizde, Ocak 2012 ile Mart 2013 arasında torasik cerrahi geçiren ve ameliyat sonrası analjezi amacıyla ultrason rehberliğinde TPVB uygulanan hastalar geriye dönük olarak incelendi. Demografik veriler, blok tekniği, komplikasyonlar ve birinci, altıncı, 12., 24. saat Vizüel Analog Skala (VAS) skorları kaydedildi. Bulgular: Toplam 18 hastaya TPVB uygulandı. Dokuz hastaya tek enjeksiyonla, beş hastaya çoklu enjeksiyonla ve dört hastaya ise kateter yardımı ile TPVB uygulandığı tespit edildi. İstatistiksel olarak anlamlı olmamakla birlikte tekli enjeksiyon ve kateter gruplarında ilk saatteki VAS skorunun üçün üzerinde olduğu tespit edildi. Sonuç: Ultrason rehberliğinde tek enjeksiyon TPVB, çoklu enjeksiyon ve sürekli TPVB uygulamalarında olduğu gibi ameliyat sonrası ilk 24 saat etkin analjezi sağlayabilmektedir.Anahtar sözcükler: Postoperatif analjezi; torasik paravertebral blok; ultrason rehberliği. SummaryObjectives: Ultrasound-guided thoracic paravertebral block (TPVB) may be employed for postoperative analgesia in thoracic surgery. In application of TPVB, single injections, multiple injections or catheter techniques may be used. In this paper we present our experiences with ultrasound-guided TPVB in thoracic surgery patients for postoperative analgesia. Methods: Patients undergoing thoracic surgery and on whom ultrasound-guided TPVB was performed for postoperative analgesia from January 2012 to March 2013 in our clinic were analyzed retrospectively. Demographic data, block technique, complications and 1 st , 6 th , 12 th and 24 th hour VAS scores were recorded. Results: A total of 18 patients had TPVB. Single injection was administered to 9 patients, multiple injections to 5, and catheters to 4. While statistically insignificant, 1st hour VAS scores were found to be greater than 3 in the single injection and catheter groups. Conclusion: Similarly to multiple injection and continuous TPVB administration, ultrasound-guided single injection TPVB provides effective 24-hour postoperative analgesia.

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Varying anatomical injection points within the thoracic paravertebral space: effect on spread of solution and nerve blockade

Cited by 106 publications

References 20 publications

The ultrasound-guided retrolaminar block

The ultrasound-guided retrolaminar block

The location of paravertebral catheters placed using the landmark technique

Our ultrasound guided paravertebral block experiences in thoracic surgery

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