A single paravertebral injection via a needle vs. a catheter for the spreading to multiple intercostal levels: a randomized controlled trial

Abstract

Purpose

Thoracic paravertebral block (TPVB) provides a unilateral nerve block at multiple intercostal levels allowing injection of a local anesthetic into paravertebral space (PVS) via a needle or catheter. However, the most effective injection method remains unclear. This study compared the real-time spread of ropivacaine between two paravertebral injection methods using thoracoscopy.

Methods

Thirty-four patients scheduled for thoracoscopic surgery were randomly allocated into the Needle or Catheter groups, and performed transverse in-plane ultrasound-guided TPVB. The Needle group received 20 ml of 0.5% ropivacaine via a needle placed into the lateral edge of PVS; the Catheter group received the same dose of ropivacaine via a catheter inserted 5 cm into PVS. The primary outcome was the spreading pattern of ropivacaine in each group. The secondary outcome was intraoperative vasopressor requirement after paravertebral injection.

Results

In the Needle group, all cases showed ropivacaine spread to multiple intercostal levels, mainly across the ribs. Contrastingly, the Catheter group showed variable spreading patterns; multiple intercostal levels (n = 10) [across the ribs (n = 4), anterolateral aspect of the vertebral bodies (n = 6)] or unobservable spreading (no change; n = 7) (P = 0.007). Vasopressors were required in two and ten cases in the Needle and Catheter groups, respectively (P = 0.010).

Conclusion

Paravertebral injection via a needle typically resulted in spreading to multiple intercostal levels, especially across the ribs on the peripheral side of injection site, whereas injection via a catheter resulted in variable spreading patterns. Therefore, injections via needles are more stable.

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Acknowledgements

The authors would like to express their profound gratitude to M. Nishimura (Department of Thoracic Surgery, Tosei General Hospital, Seto, Japan) for assistance with the thoracoscopy procedures for all the cases. The authors also thank Editage (https://www.editage.jp/) for providing professional editing services.

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Correspondence to Kimitoshi Nishiwaki.

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Online Resource 1: Video 1. Injection via a Tuohy needle with spread across the ribs. A local anesthetic is injected into a thoracic paravertebral space via a Tuohy needle placed into the lateral edge of the paravertebral space. The local anesthetic mainly spreads into the multiple intercostal levels, especially across the ribs at the peripheral side of injection site. (MPG 6164 kb)

Online Resource 2: Video 2. Injection via a catheter and spreading at the anterolateral aspect of vertebral bodies. A local anesthetic is injected into a thoracic paravertebral space via a paravertebral catheter. The local anesthetic mainly spreads into the anterolateral aspect of vertebral bodies around the sympathetic trunk at multiple intercostal levels. (MPG 3390 kb)

Online Resource 3: Video 3. Injection via a catheter and spreading across the ribs. A local anesthetic is injected into a thoracic paravertebral space via a paravertebral catheter. The local anesthetic mainly spreads into the multiple intercostal spaces across the ribs. (MPG 3668 kb)

Online Resource 4: Video 4. Injection via a catheter and an unobservable spreading pattern. A local anesthetic is injected into a thoracic paravertebral space via a paravertebral catheter. The spreading of the local anesthetic is not identified under thoracoscopy. (MPG 2586 kb)

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Fujii, T., Shibata, Y., Ban, Y. et al. A single paravertebral injection via a needle vs. a catheter for the spreading to multiple intercostal levels: a randomized controlled trial. J Anesth 34, 72–78 (2020). https://doi.org/10.1007/s00540-019-02713-6

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Keywords

  • Catheter
  • Needle
  • Paravertebral injection
  • Regional anesthesia
  • Thoracic paravertebral block