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EFFECTS OF CATHETER TIP LOCATION ON THE SPREAD OF SENSORY BLOCK CAUSED BY A CONTINUOUS THORACIC PARAVERTEBRAL BLOCK: A PROSPECTIVE, RANDOMIZED, CONTROLLED, DOUBLE-BLIND STUDY
ESRA Academy. Watanabe Y. Sep 8, 2016; 138279
Topic: Thoracic Paravertebral and Intercostal Blocks
Dr. Yoshiko Watanabe
Dr. Yoshiko Watanabe

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Abstract
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Background and Aims:

Single injections in the ventral region of the thoracic paravertebral space (TPVS) tend to generate a multi-segmental longitudinal spreading pattern. We examined the hypothesis that continuous thoracic paravertebral block (CTPVB) administered through a catheter inserted into the ventral region of the TPVS allows a wider sensory block dispersion.

Methods:

This study was approved by the Research Ethics Committee of our institute, and 50 consecutive patients undergoing video-assisted thoracic surgeries were enrolled. Before the surgery, an infusion catheter was inserted into the TPVS adjacent to either the parietal pleura (P group) or internal intercostal membrane (I group), using an ultrasound-guided intercostal transverse approach, according to a randomized allocation schedule. After the surgery, a chest radiograph was obtained after injection of radiopaque dye through the catheter. Thereafter, CTPVB with 0.25% levobupivacaine was initiated at 8 mL/h. The primary outcome was the number of blocked dermatomes 24 h after surgery. The secondary outcomes included the number of segments covered by the dye. A p value < 0.05 was considered statistically significant.

Results:

The median (interquartile range [range]) number of blocked dermatomes 24 h after the surgery was 3 (2.75–4 [1–6]) in the P group (n = 22) and 2 (1.5–3 [0–7]) in the I group (n = 25) (p = 0.04). No significant differences were found in the other outcomes between the groups.

Conclusions:

CTPVB administered using the catheter inserted adjacent to the parietal pleura allows a wider sensory block dispersion compared to the catheter inserted adjacent to the internal intercostal membrane.REC approval certificate

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