title: Spread of dye after single thoracolumbar paravertebral injection in infants. A cadaveric study.
abstract: BACKGROUND
  Thoracolumbar paravertebral block (PVB) is one method of providing regional anaesthesia for abdominal wall surgery in children. It is common practice when performing a PVB for abdominal wall anaesthesia to inject a certain volume of local anaesthetic solution in the paravertebral space at several levels. This increases the duration of the procedure and makes it more invasive.
  
  
  OBJECTIVE
  To determine the character of dye spread in infants' paravertebral space, to check the feasibility of single injection PVB and to determine the optimal volume of injectate necessary to cover the paravertebral segments responsible for sensation of the lower abdomen.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  Single centre, University Hospital, April 2013 to August 2013.
  
  
  METHODS
  Twenty infant cadavers.
  
  
  METHODS
  Ultrasound-guided, single thoracolumbar paravertebral injections were performed on infant cadavers.
  
  
  METHODS
  The total number of paravertebral segments stained after dye injection and specific vertebral levels of cephalad and caudad spread of dye in the paravertebral space.
  
  
  RESULTS
  Dye was present in the paravertebral spaces of all cadavers. Spread of dye within the paravertebral space was different depending on dye volume. Strong correlation was found between the volume of injectate and the number of paravertebral segments involved. The number of spinal nerve roots surrounded with dye corresponded with the number of paravertebral segments involved. T11, T12 and L1 nerve roots were stained in all cadavers. The optimal injectate volume to involve T10-L1 segments was defined as 0.2 to 0.3  ml  kg(-1).
  
  
  CONCLUSIONS
  Single thoracolumbar paravertebral injection at T12-L1 level leads to caudad and cephalad spread of injectate in a dose-dependent manner. Single injection thoracolumbar paravertebral injections could be performed for lower abdomen anaesthesia in infants. We suggest that a single injection of 0.2 to 0.3  ml  kg(-1) of local anaesthetic in the thoracolumbar paravertebral space could provide adequate coverage of the dermatomes of the lower abdomen.
authors.affiliation: From the Regional Children's Clinic Hospital, Lviv, Ukraine.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Albokrinov
authors.forename: Ulbolgan A
authors.initials: UA
authors.lastname: Fesenko
mesh_terms: D002102:Cadaver; D004396:Coloring Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007278:Injections, Spinal; D008159:Lumbar Vertebrae; D008297:Male; D009407:Nerve Block / Q000379:methods*; D013126:Spinal Nerve Roots / Q000378:metabolism; D013131:Spine / Q000378:metabolism; D013904:Thoracic Vertebrae
chemical_list: D004396:Coloring Agents