The Challenges of Ultrasound-guided Thoracic Paravertebral Blocks in Rib Fracture Patients

Wardhan, Richa; Kantamneni, Sowmya

doi:10.7759/cureus.7626

Cited by 2 publications

(1 citation statement)

References 20 publications

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“…Thoracic paravertebral (TPV) block was first described in 1905 and was introduced into clinical practice by Ethan and Wyatt in 1978. 1 With the popularity of visualization technology, ultrasound-guided (US)-TPV block has been widely carried out in clinical practice, 2 , 3 such as for anesthesia for thoracotomy, 4 breast surgery, 5 rib fracture surgery, 6 cardiac surgery, 7 and analgesia for herpes zoster neuralgia. 8 Although US-TPV block is generally considered safe, complications such as pneumothorax, vasovagal episodes, symptomatic bradycardia, and hypotension have been reported.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Extraforaminal Thoracic Nerve Root Block Through the Midpoint of the Inferior Articular Process and the Parietal Pleura: A Clinical Application of Thoracic Paravertebral Nerve Block

Han

et al. 2022

JPR

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Purpose Thoracic nerve root (TNR) block is performed primarily under computed tomography or X-ray fluoroscopy but is associated with radiation exposure. Ultrasound requires no radiation and distinguishes vessels, nerves, pleura, and other tissues. Few reports of ultrasound-guided TNR (US-TNR) block have been described, and the puncture end point has not been clearly defined. Herein, we evaluated the feasibility of US-TNR block using the midpoint of the inferior articular process (IAP) and parietal pleura (PP) as the puncture end point. Patients and Methods A prospective series of 10 patients with Herpes Zoster-associated pain underwent US-TNR-guided block performed using an in-plane technique with the midpoint of thoracic IAP and PP as the puncture end points of ultrasonography. The US-TNR block procedure was performed with ultrasound as the primary imaging tool followed by fluoroscopic confirmation. Results In all patients, the needle tips were visible at the lateral margin of the pedicle in the anteroposterior view and at the extraforaminal zone in the lateral view. The TNR and dorsal root ganglion (DRG) were delineated in all 10 patients. Furthermore, 2 mL of radiopaque agent could delineate the epidural space in 8 patients and the thoracic paravertebral (TPV) space in the other 2 patients. All patients developed numbness along the corresponding dermatome 30 min after injection of local anesthetics. The numeric rating scale (NRS) score at baseline, and at two- and four-week follow-ups were 6.50 ± 1.35, 3.50 ± 0.85 (vs NRS at baseline, P < 0.01), and 4.00 ± 0.82 (vs NRS at baseline, P < 0.01), respectively. Conclusion This study demonstrated the feasibility of US-TNR block using the in-plane technique with the midpoint of thoracic IAP and PP as the puncture end point to effectively block the TNR and DRG. This technique is an accurate clinical application of TPV nerve block and provides a potential therapeutic option for the treatment of neuropathic pain.

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Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Extraforaminal Thoracic Nerve Root Block Through the Midpoint of the Inferior Articular Process and the Parietal Pleura: A Clinical Application of Thoracic Paravertebral Nerve Block

Han

et al. 2022

JPR

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Abdominal flank bulge following intercostal neurectomy for symptomatic rib fracture nonunion

Prins

Wijffels

2021

BMJ Case Rep

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The gold standard for rib fracture nonunion management remains a matter of debate. Operative treatment of rib fracture nonunion has become increasingly popular. A 69-year-old man was operatively treated with intercostal neurectomy of the left eighth rib to resolve chronic thoracic pain following a rib fracture nonunion. After the intervention, the patient developed a flank bulge which was most likely due to the intercostal neurectomy, causing partial denervation of the abdominal musculature. Although the pain at the nonunion site decreased after the operative intervention, the patient still experienced severe pain during daily activities and reported poor quality of life due to the flank bulge. Physiotherapy and an abdominal belt did not improve this flank bulge. When considering operative neurectomy of the intercostal nerves of ribs 7–12 to resolve chronic pain due to rib fracture nonunion, the treating surgeon should be aware of this debilitating complication.

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The Challenges of Ultrasound-guided Thoracic Paravertebral Blocks in Rib Fracture Patients

Cited by 2 publications

References 20 publications

Ultrasound-Guided Extraforaminal Thoracic Nerve Root Block Through the Midpoint of the Inferior Articular Process and the Parietal Pleura: A Clinical Application of Thoracic Paravertebral Nerve Block

Ultrasound-Guided Extraforaminal Thoracic Nerve Root Block Through the Midpoint of the Inferior Articular Process and the Parietal Pleura: A Clinical Application of Thoracic Paravertebral Nerve Block

Abdominal flank bulge following intercostal neurectomy for symptomatic rib fracture nonunion

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