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Intercostal catheterisation. An alternative approach to the paravertebral space
A Mowbray1, K K Wong, J M Murray
1Department of Anaesthesia, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
Anaesthesia
|September 1, 1987
Summary
Intercostal catheterization for pain relief after chest surgery often involves spread to the paravertebral space. This paravertebral spread is likely responsible for the extensive dermatomal block observed in patients.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Pain Management
Background:
- Intercostal catheterization is a common method for postoperative pain management.
- The precise spread pattern of local anesthetics via intercostal catheters is not fully understood.
Purpose of the Study:
- To investigate the spread of local anesthetic solution injected via pre-operative intercostal catheters during thoracotomy or median sternotomy.
- To determine the contribution of paravertebral spread to the overall block achieved with intercostal catheterization.
Main Methods:
- Twenty-one patients undergoing thoracotomy or median sternotomy received pre-operative intercostal catheters.
- A solution of bupivacaine and methylene blue was injected, and its spread was visualized directly during surgery.
- The extent of dye spread involving intercostal and paravertebral spaces was documented.
Main Results:
- Dye spread typically involved one to two intercostal spaces.
- In most patients, the dye spread medially to the paravertebral space.
- Paravertebral spread extended both cranially and caudally, affecting two to five vertebral segments, with some contralateral spread observed.
Conclusions:
- Paravertebral spread is a significant factor in the dermatomal block achieved with intercostal catheterization.
- This understanding can optimize anesthetic techniques for thoracic procedures.
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