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

• Published in: Anaesthesia Vol. 59; no. 5; pp. 459 - 463
• Main Authors: Naja, M. Z., Ziade, M. F., Rajab, M. El, Tayara, K. El, Lönnqvist, P. A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.05.2004; Blackwell
• Subjects: Adult; Aged; Anatomy; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Anesthetics, Local - pharmacokinetics; Biological and medical sciences; Contrast Media - pharmacokinetics; Electric Stimulation; Female; Humans; Iohexol - pharmacokinetics; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Nerve block; Nerve Block - methods; Pain, Postoperative - prevention & control; paravertebral blockade; Postoperative pain; Radiography, Thoracic; Single-Blind Method; Thoracic Vertebrae; Nerve; Anesthesia; Injection; Nerve block: paravertebral blockade. Postoperative pain. Anatomy; Solution
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/j.1365-2044.2004.03705.x

Summary 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.