Anatomical bases for paravertebral an esthetic block: fluid communication between the thoracic and lumbar paravertebral regions

Saito, T.; Den, S.; Tanuma, Kumiko; Tanuma, Yutaka; Carney, E.; Carlsson, Christina

doi:10.1007/s00276-999-0359-4

Cited by 20 publications

(38 citation statements)

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“…Studies on the distribution of PVB on volunteers, patients and cadavers have all confirmed the potential for vertical spread of the TPVS over multiple adjacent segmental levels [8,13,14]; however, no paravertebral spread is possible below the level of the first lumbar vertebra due to the origin of the psoas muscle [11]. Involvement of lumbar segments can occasionally be seen and is most likely due to tracking of local anaesthetics alongside the lateral boarder of the psoas muscle [15] but is not a sign of true lumbar paravertebral spread of the block.…”

Section: Discussionmentioning

confidence: 95%

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

Naja¹,

et al. 2004

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SummaryThe 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.

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Section: Discussionmentioning

confidence: 95%

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

Naja¹,

et al. 2004

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“…We confirmed injection of the anesthetic solution into the endothoracic fascia by introducing a radio-opaque dye through a catheter left in place for drug infusion. After this initial clinical experience, we studied the spread of anesthetic solution in the thoracic paravertebral space into the abdominal region and observed a fluid communication between the endothoracic fascia in the lower thoracic paravertebral region and the transversalis fascia in the abdominal cavity posterior to the lateral and medial arcuate ligaments (Saito et al, 1996(Saito et al, , 1999. In these studies we observed that the celiac ganglion was colored by the spread of dye in some cadavers.…”

Section: Discussionmentioning

confidence: 90%

“…In a subsequent anatomic study, we observed that the anesthetic solution traveled to the lumbar paravertebral region in the transversalis fascia from the endothoracic fascia, explaining the cause of the block in the lumbar nerve segments (Saito et al, 1999). During this study we observed that dye spread toward the celiac ganglion in some cadavers.…”

Section: Introductionmentioning

confidence: 88%

“…Fluid communication between the endothoracic fascia in the thoracic cavity and the celiac ganglion in the abdominal cavity is not well understood (Tenicela and Pollan, 1990;Karmakar and Chung, 1999;Saito et al, 1999). In anesthesiology, it is known that an injection of local anesthetic into the endothoracic fascia produces unilateral analgesia, a procedure termed thoracic paravertebral block (Barash et al, 1989;Richardson and Lonnqvist, 1998).…”

Section: Introductionmentioning

confidence: 97%

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Pathways of anesthetic from the thoracic paravertebral region to the celiac ganglion

et al. 2002

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Communication between the lower thoracic paravertebral region and the celiac ganglion through the retrocrural space was investigated. After dye was injected into the endothoracic fascia in the lower thoracic paravertebral region at the T11 level, its spread to the celiac ganglion was examined in fifteen cadavers. The dye reached the celiac ganglion in nine cadavers (60%) by passing through the retrocrural space, along the greater and lesser splanchnic nerves and through the split in the crus of the diaphragm through which the splanchnic nerves traveled. In the remaining six cadavers, dye spread toward the ganglion along the crus of the diaphragm. In three living subjects the spread of a radio-opaque dye injected in the same manner was studied using 3D-computed tomography. This study confirmed that the radio-opaque dye traveled toward the celiac ganglion along the crus of the diaphragm. From our results we suggest that a fluid communication may exist between the lower thoracic paravertebral region and the celiac ganglion in cadavers and in living humans and that clinicians should be aware of this possible route of spread when administering lower thoracic paravertebral anesthesia. Clin. Anat. 15:340 -344, 2002.

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“…Ropivacaine, structurally related to bupivacaine, is a new amide that has been has been investigated as a long-acting local anesthetic. It has been widely investigated for its regional analgesic effects during labor or postoperatively, but there are limited studies with regard to lumbar plexus blockade and none of them are in elderly patients [14][15][16][18][19][20] . Evaluation of the incidence of central nervous system symptoms and changes in echocardiography and electrophysiology revealed that the maximum tolerated dose is higher for ropivacaine than bupivacaine [9,16] .…”

Section: Discussionmentioning

confidence: 99%

Lumbar Plexus Blockade with Ropivacaine for Postoperative Pain Management in Elderly Patients Undergoing Urologic Surgeries

Akın¹,

Aribogan

Turunç³

et al. 2005

Urol Int

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Background/Aims: We evaluated the effectiveness and safety of lumbar plexus blockade with ropivacaine for postoperative pain relief in elderly patients undergoing flank incision for urological surgery. Methods: 60 urological patients (>65 years old) were chosen randomly for paravertebral lumbar blockade. Postoperatively ropivacaine was used in group I (n = 30) and bupivacaine was administered in group II (n = 30) for lumbar plexus blockade. Heart rates, systolic and diastolic blood pressures, peripheral oxygen saturations, analgesia levels with visual analogue scales (VAS) were measured postoperatively at 5 and 30 min and 1, 3, 6, 8,and 12 h. Patient satisfaction scores and complications were recorded. Results: The hemodynamic parameters of the groups were in the normal ranges (p > 0.05). VAS were significantly decreased at 60 min in both groups (p < 0.05) and no important increase was observed during the first 8 h (p > 0.05). After the 8-hour measurement, analgesic was given to 7 patients in group I and 6 patients in group II (p < 0.05). There were no complications (p > 0.05). Patient satisfaction scores were found to be higher for all patients (p > 0.05). Conclusion: In elderly patients, lumbar plexus blockade with ropivacaine can be a simple, safe and effective analgesic technique especially in the early postoperative period after urologic surgeries with flank incision.

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Anatomical bases for paravertebral an esthetic block: fluid communication between the thoracic and lumbar paravertebral regions

Cited by 20 publications

References 0 publications

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

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

Pathways of anesthetic from the thoracic paravertebral region to the celiac ganglion

Lumbar Plexus Blockade with Ropivacaine for Postoperative Pain Management in Elderly Patients Undergoing Urologic Surgeries

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