Intercostally placed paravertebral catheterization: an alternative approach to continuous paravertebral blockade

Area of Science:

• Anesthesiology
• Pain Management
• Surgical Procedures

Background:

• Continuous paravertebral nerve blocks are effective for postoperative analgesia in abdominal and thoracic surgery.
• The classic approach to the paravertebral space can be challenging.
• Percutaneous intercostal blockade offers a potential alternative for accessing the paravertebral space.

Purpose of the Study:

• To evaluate the efficacy and safety of continuous paravertebral blockade via an intercostal approach for postoperative analgesia.
• To assess pain scores and opioid consumption in patients undergoing major surgery with this technique.

Main Methods:

• 110 patients undergoing major abdominal, thoracic, or retroperitoneal procedures received preoperative paravertebral catheter placement via an intercostal approach.
• A Tuohy needle was advanced to contact the rib, then "walked-off" to lie in the subcostal groove for catheter insertion.
• Postoperatively, continuous ropivacaine infusion was administered with patient-controlled boluses for breakthrough pain.

Main Results:

• Median pain scores were 2/10, and patient-controlled analgesia hydromorphone consumption averaged 1.69 mg in the first 24 hours.
• No clinically significant complications were reported with the intercostal paravertebral catheter technique.

Conclusions:

• The intercostally placed paravertebral catheter effectively provides postoperative analgesia.
• This technique is suitable for major chest, abdominal, or retroperitoneal surgeries.