Catheterization in an ultrasound-guided thoracic paravertebral block using thoracoscopy

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Medical Imaging

Background:

• Thoracic paravertebral block (TPVB) is an effective alternative to epidural anesthesia for thoracic procedures.
• Previous studies on TPVB catheter location in the thoracic paravertebral space (TPVS) relied on cadaver models.
• The in-vivo mechanism of catheter advancement within the TPVS during TPVB remains unclear.

Purpose of the Study:

• To visualize real-time catheter insertion and advancement within the TPVS during ultrasound-guided TPVB.
• To determine the extent of catheter spread beyond the ribs within the TPVS.
• To inform optimal catheter placement strategies for TPVB.

Main Methods:

• Ultrasound-guided TPVB using a parasagittal in-plane approach.
• Real-time thoracoscopic observation of the thoracic cavity during catheterization.
• Assessment of catheter advancement caudally beyond the ribs into the TPVS.

Main Results:

• Catheter advancement beyond the ribs into the TPVS was observed to be difficult.
• The paravertebral catheter was largely confined to the same anatomical level as insertion.
• Limited caudal spread of the catheter within the TPVS was noted.

Conclusions:

• Catheter advancement in TPVB is restricted, often remaining at the insertion level.
• Local anesthetic spread may be concentrated at the intercostal level of injection.
• TPVB catheter insertion should ideally correspond to the thoracotomy incision site for optimal coverage.