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Thoracic paravertebral spread using two different ultrasound-guided intercostal injection techniques in human
Tilemachos Paraskeuopoulos1, Theodosios Saranteas, Konstantinos Kouladouros
1Department of Anatomy, University of Athens, School of Medicine, Athens, Greece. tilepara@yahoo.gr.
Clinical Anatomy (New York, N.Y.)
|July 20, 2010
Summary
Ultrasound-guided injections into the intercostal space successfully accessed the thoracic paravertebral space in cadavers. These techniques offer a promising alternative for thoracic paravertebral anesthesia.
Area of Science:
- Anatomy
- Medical Imaging
- Regional Anesthesia
Background:
- The thoracic paravertebral space is crucial for regional anesthesia.
- Establishing reliable access to this space is essential for effective pain management.
- Previous studies confirm the anatomical continuity between intercostal and paravertebral spaces.
Purpose of the Study:
- To evaluate the efficacy of two distinct ultrasound-guided techniques for achieving paravertebral spread from the intercostal space.
- To compare the success rates and safety of transverse versus longitudinal probe placements for dye injection.
Main Methods:
- Utilized eleven embalmed human cadavers, scanning the thoracic region (T5-T7) with a linear probe.
- Employed a transverse technique: probe below the rib, needle insertion between internal intercostal membrane and pleura.
- Employed a longitudinal technique: probe 5 cm lateral to spinous processes, needle insertion between internal intercostal membrane and pleura.
- Injected 1 ml of methylene blue dye in both techniques, performing 33 injections total (19 transverse, 14 longitudinal).
Main Results:
- Successful spread to the thoracic paravertebral space was achieved in 89.5% of transverse technique injections.
- Successful spread was achieved in 92.8% of longitudinal technique injections.
- No instances of intrapleural dye spread were observed with either technique.
Conclusions:
- Ultrasound-guided injection into the intercostal space is an effective method for accessing the thoracic paravertebral space.
- Both transverse and longitudinal techniques demonstrated high success rates with excellent safety profiles.
- These intercostal space approaches represent viable alternatives for thoracic paravertebral interventions.
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