Ultrasound-guided thoracic paravertebral block using a transverse in-plane approach at the level of the inferior articular process: a retrospective review of complications

• Published in: Regional anesthesia and pain medicine Vol. 49; no. 10; p. 770
• Main Authors: Karmakar, Manoj Kumar, Pakpirom, Jatuporn, Sivakumar, Ranjith Kumar, Samy, Winnie
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 08.10.2024
• Subjects: Aged; Body mass index; Breast cancer; Breast surgery; Cancer surgery; Cardiac arrhythmia; Data analysis; Female; Humans; Hypotension; Intensive care; Literature reviews; Male; Mastectomy; Medical ethics; Middle Aged; Nerve Block - adverse effects; Nerve Block - methods; Neurological disorders; Patients; Pneumothorax; Regional anesthesia; Retrospective Studies; Thoracic Vertebrae - diagnostic imaging; Ultrasonic imaging; Ultrasonography, Interventional - methods; Hong Kong China; China; Anesthesia, Conduction; COMPLICATIONS; Ultrasonography; analgesia
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2022-103983

The USG TPVB was performed as described previously,4 using a transverse in-plane approach at the level of the inferior articular process (figure 1).4 Details regarding the indications for TPVB, LA dose, adjuvant block performed, working definition for the complications, general anesthesia (GA) technique, sedation, and statistical analysis used are provided in online supplemental file 1. The primary outcome variable was the overall incidence of complications (table 1).Table 1 Demographic data, block characteristics and complications Variable n=382 Age in years 58.1±12.5 Gender (female/male) 376 (98.4%)/6 (1.6%) Weight in kg 59.1±10.9 Height in cm 156.2±5.9 BMI in kg/m2 24.3±4.2 Type of surgery BCT and SLNB 72 (18.8%) BCT and axillary dissection 13 (3.4%) Mastectomy and SLNB 129 (33.8%) Modified radical mastectomy 168 (44%) Mode of anesthesia TPVB combined with general anesthesia (indication: analgesia) 150 (39.3%)  TPVB—single injection (T3) 87 (58%)  TPVB—three injections (T2-T4-T6) 63 (42%)  Total no of TPVB injections performed 276  Hypotension requiring vasopressor and or fluid therapy during the intraoperative period 49 (32.7%)*  Hypotension requiring vasopressor and or fluid therapy in the post anesthesia care unit 3 (2%) TPVB in conjunction with sedation (indication: surgical anesthesia) 232 (60.7%)  TPVB—single injection 4 (1.7%)  TPVB—two injections 24 (10.3%)  TPVB—three injections 57 (24.6%)  TPVB—four injections 12 (5.2%)  TPVB—five injections 11 (4.7%)  TPVB—six injections 121 (52.1%)  TPVB—seven injections 3 (1.3%)  Total no of TPVB injections performed 1073  Hypotension requiring vasopressor and or fluid therapy during the intraoperative period 21 (9.1%)  Hypotension requiring vasopressor and or fluid therapy in the post anesthesia care unit 11 (4.7%) Overall incidence of complications 84 (21.9%) Individual Complication  Vascular puncture 3 (0.8%)  Paraspinal intramuscular hematoma 1 (0.3%)  Pleural puncture 0 (0%)  Pneumothorax 0 (0%)  Bradycardia 5 (1.3%)  Hypotension 70 (18.3%)  Horner’s syndrome 3 (0.8%)  Recurrent laryngeal nerve palsy (hoarseness of voice n=1, aphonia n=1) 2 (0.5%) Demographic data, block characteristics and complications. [...]USG TPVB using the transverse in-plane approach at the inferior articular process level is frequently associated with transient hypotension and a zero incidence of clinically detectable pleural puncture or pneumothorax. Ethics approval This study was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Reference No: 2018.298, 12 July 2018) and registered with the Chinese clinical trials registry (ChiCTR1800018354, August 9, 2018, https://www.chictr.org.cn/showprojen.aspx?proj=31087). Since this was a retrospective review, patient consent was waived.