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Paravertebral-peridural block technique: a unilateral thoracic block.

R Tenicela¹, S B Pollan

¹Pain Control Center, Presbyterian-University Hospital, Pittsburgh, Pennsylvania.

The Clinical Journal of Pain

|September 1, 1990

Summary

The paravertebral-peridural block offers a safe and effective method for unilateral thoracic anesthesia across multiple dermatomes. This technique provides reliable pain relief with a low complication rate, benefiting patients with acute and chronic pain.

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Area of Science:

Anesthesiology
Pain Management
Thoracic Surgery

Background:

Achieving unilateral anesthesia in multiple thoracic dermatomes is crucial for pain management.
The multidermatomal intercostal technique's mechanism is debated.
A modified paravertebral block, termed paravertebral-peridural block, has been utilized for over two decades.

Purpose of the Study:

To evaluate the safety and efficacy of the paravertebral-peridural block for unilateral anesthesia.
To clarify the anatomical mechanism behind potential bilateral blockade from this unilateral technique.

Main Methods:

Retrospective analysis of 384 paravertebral-peridural blocks performed between 1982 and 1986.
Cadaveric injection study using colored latex to visualize spread after paravertebral-peridural approach.

Main Results:

Low complication rates: 0.26% pneumothorax, 0.26% thecal puncture, 0.52% intrathecal injection, 4.6% transient hypotension.
93% of blocks were rated "good" or "excellent".
Cadaver study revealed prevertebral midline spread to the contralateral paravertebral space, explaining bilateral blockade.

Conclusions:

The paravertebral-peridural thoracic block is a reliable and safe technique.
It effectively achieves unilateral anesthesia over multiple dermatomes with a single injection.
Understanding the anatomical spread clarifies the mechanism of action.