Thoracic paravertebral block: comparison of different approaches and techniques. A study on 27 human cadavers
| Autor: | Thomas Bessede, Régis Renard, Laura Ruscio, Dan Benhamou, Paul Zetlaoui, Cedric Lebacle |
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| Přispěvatelé: | Petites Molécules de neuroprotection, neurorégénération et remyélinisation, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM) |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Epidural Space
Male [SDV]Life Sciences [q-bio] Critical Care and Intensive Care Medicine Anesthesia Spinal Thoracic Vertebrae Injections 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Cadaver medicine Humans Paravertebral Block 030212 general & internal medicine Anatomical dissection Ultrasonography Interventional Loss of resistance Aged Anesthetics Aged 80 and over Human cadaver business.industry General Medicine Sagittal plane Ultrasound guidance Anesthesiology and Pain Medicine medicine.anatomical_structure Paravertebral Injection Female Anatomic Landmarks Nuclear medicine business |
| Zdroj: | Anaesthesia Critical Care & Pain Medicine Anaesthesia Critical Care & Pain Medicine, 2020, 39, pp.53-58. ⟨10.1016/j.accpm.2019.04.003⟩ |
| ISSN: | 2352-5568 |
| DOI: | 10.1016/j.accpm.2019.04.003⟩ |
| Popis: | The success rate and spread of thoracic paravertebral block (TPVB) are variable and difficult to predict. It is now recommended that an ultrasound guidance technique should replace the traditional landmark technique. The objective was to compare anatomical outcomes of both techniques on cadavers.A landmark technique (loss of resistance technique [LOR]) and a USG technique (three approaches: sagittal, transversal in-plane, transverse out-of-plane) were performed on 27 thawed non-embalmed cadavers. Each of the four approaches was performed in each body (T3-T5 and T9-T11 × right and left). A coloured solution (13 mL, saline 0.9%) was injected in the targeted thoracic paravertebral space (TPVS). A successful thoracic paravertebral injection (TPVI) was defined by the presence of dye in at least one TPVS during anatomical dissection.In 104 TPVIs analysed, the overall success rate was 78%. Factors associated with success were: USG versus LOR technique (85% vs. 52%, P 0.0007), sagittal versus both transversal approaches (93%/81%/83%, P 0.0007) and right side (86% vs. 66%). The median spread was 2 TPVS (min - max 1-5) with a median cephalad-caudal spread of 5 cm (min - max 1-18). By multivariate analysis, the sagittal approach was an independent factor of success (OR 2.75). Dye spread and pleural entry were influenced by neither the approach nor the site of injection.Paravertebral spread of TPVI is variable. USG technique has higher anatomical success rates than the LOR technique, the sagittal USG approach being the most successful. |
| Databáze: | OpenAIRE |
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