Varying anatomical injection points within the thoracic paravertebral space: effect on spread of solution and nerve blockade.
The factors responsible for the spreading pattern of a single paravertebral injection are still uncertain. In this study, 28 patients were randomly assigned to receive a paravertebral injection of radio-opaque dye (10 ml, with or without co-administration of 20 ml of local anaesthetics) either dorsal or ventral to the endothoracic fascia. The point of injection was determined by use of a nerve-stimulator and the radiographic distribution pattern was assessed blindly by a radiologist. Injections made in the more ventral part of the thoracic paravertebral space, supposedly anterior to the endothoracic fascia, resulted in a multisegmental longitudinal spreading pattern, whereas injections made dorsal to the endothoracic fascia resulted in a less predictable cloud-like spreading pattern, with only limited distribution over adjacent segments. The use of a nerve stimulator-guided technique appears to enhance the likelihood of achieving the more desirable longitudinal spreading pattern.
Naja
M Z
MZ
Department of Anaesthesia and Pain Medicine, Makassad General Hospital, Beirut, Lebanon. zouhnaja@yahoo.com
Ziade
M F
MF
El Rajab
M
M
El Tayara
K
K
Lönnqvist
P A
PA
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000493:pharmacokinetics; D003287:Contrast Media / Q000493:pharmacokinetics; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007472:Iohexol / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D013902:Radiography, Thoracic; D016037:Single-Blind Method; D013904:Thoracic Vertebrae
D000779:Anesthetics, Local; D003287:Contrast Media; D007472:Iohexol