Sonographic measurement of needle insertion depth in paravertebral blocks in women

Abstract

Single-injection paravertebral block offers adequate unilateral analgesia for thoracic and upper abdominal surgery. This technique is easy to learn but there is a risk, albeit low, of pleural puncture. The aim of the study was to determine whether sonographic measurements of the distances from the skin to the transverse process and to the parietal pleura are useful for calculating the required depth of needle insertion. Before puncture of the paravertebral space, the distances from the skin to the transverse process and to the parietal pleura were measured by sonography. The deviation of the needle from the horizontal plane was measured and an angle correction for the insertion depth was calculated. Twenty-two women undergoing elective unilateral breast surgery were studied. Sonographic visualization of the transverse process and the parietal pleura and measurement of their distances from the skin was successful in all women. Puncture of the paravertebral space failed in one obese woman. There was a very close correlation between needle insertion depth from the skin to the transverse process and the distance measured by ultrasound if angle correction was used (adjusted r2=0.95). Similarly, there was excellent correlation between the angle-corrected ultrasound distance from the skin to the parietal pleura and the distance from the skin to the paravertebral space (adjusted r2=0.92).

Ultrasound Guidance Is Helpful for Paravertebral Block Performance and Catheter Placement in Patients with Laminectomy after Thoracotomy or Lumbotomy: A Case Series Imaging Study

“…First, we could infiltrate the PV area easily, but similar to the description of Luyet et al [8], the catheter placement was difficult in only one patient (Patient 2), in which we needed to readjust the Tuohy needle. Otherwise, the respective depths of location were comparable to those already reported [8,9], which is especially relevant for the series of Pusch et al [9], whose patients were all female as in our series, while Riain et al [6] reported having taken the same amount of time to perform PV blocks (between 8 and 10 minutes). The main difference is the duration of the preliminary localization needed under our specific conditions because of the deep local changes resulting from the laminectomy.…”

“…Until now, the published data [6][7][8][9][10][11][12] on USG catheterization has involved only patients with normal anatomy. Among the interesting recently published data [6][7][8]11,12] are two methods to approach the PV area.…”

Single Needle Thoracic Paravertebral Block with Ropivacaine and Dexmeditomidine for Radical Mastectomy: Experience in 25 Cases

“…Nerve stimulator guidance to improve the needle-nerve position or ultrasound guidance increases the accuracy and efficacy of TPVB, thus minimizes the incidence of side effects or complications [2,9,12,14,15]. Ultrasonography is useful to guide the needle tip into the thoracic paravertebral space,visualize the catheter and drug spread allowing lesser volume of LA that minimize the risk of complications like accidental intravascular injection, pleural puncture or pneumothorax and thus improves the therapeutic success [24][25][26]. Although less practiced USG guidance is currently recommended but availability of ultrasound, adequate training and development of skill is required.…”

A multifactorial approach to the factors influencing determination of paravertebral depth

“…7,9,10 Additional postoperative benefits include a reduction in opioid requirements, earlier hospital discharge, 11 and a possible decreased risk for metastases and recurrence following surgery for breast cancer. 12 Several techniques have been described for entering the paravertebral space, including loss of resistance, nerve stimulator-guided, lateral/ intercostal approach, ultrasound assisted, 13 and even x-ray 8 and CT scan verified approaches. 14 Although the overall incidence of complications of paravertebral blocks is very low, 15,16 the risk of pneumothorax and unintended intrathecal injections remain an important clinical concern.…”