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

David A. Burns, Bruce Ben-David, Jacques E. Chelly, J. Eric Greensmith

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

BACKGROUND: Continuous paravertebral nerve blocks can provide effective postoperative analgesia after abdominal and thoracic surgery. While offering a number of advantages compared with thoracic epidural analgesia, access to the paravertebral space using a classic approach is not always easily accomplished and/or possible. In this regard, continuous paravertebral blockade via a percutaneous intercostal approach may theoretically serve as an alternative approach to the paravertebral space. METHODS: One hundred ten patients undergoing major abdominal, thoracic, or retroperitoneal procedures had preoperative placement of unilateral or bilateral paravertebral catheter(s) via an intercostal approach. At a point 8 cm lateral to the midline a 5 cm, 18 G Tuohy needle was advanced with the needle tip angled 45 degrees cephalad and 60 degrees medial to the sagittal plane to come in contact with the lower third of the rib. The needle was "walked-off" the inferior border of the rib while maintaining its orientation and advanced a further 5 to 6 mm under the rib to lie in the subcostal groove. After injection of 5 mL ropivacaine 0.5%, a catheter was advanced medially the estimated distance to the paravertebral space. Postoperatively 0.2% ropivacaine was continuously infused at 10 mL/h in each catheter with hourly boluses of 5 mL available for breakthrough pain. RESULTS: Median pain scores averaged 2 on a scale of 0-10 and patient-controlled analgesia hydromorphone consumption averaged only 1.69 mg for the first 24 h postoperatively. There were no clinically significant complications of the technique. CONCLUSION: The intercostally placed paravertebral catheter provides postoperative analgesia after major surgery of the chest, abdomen, or retroperitoneum.

Original languageEnglish (US)
Pages (from-to)339-341
Number of pages3
JournalAnesthesia and analgesia
Volume107
Issue number1
DOIs
StatePublished - Jul 2008

Fingerprint

Catheterization
Ribs
Catheters
Needles
Thorax
Analgesia
Breakthrough Pain
Hydromorphone
Preoperative Care
Patient-Controlled Analgesia
Epidural Analgesia
Nerve Block
Abdomen
Thoracic Surgery
Pain
Injections
ropivacaine

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

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title = "Intercostally placed paravertebral catheterization: An alternative approach to continuous paravertebral blockade",
abstract = "BACKGROUND: Continuous paravertebral nerve blocks can provide effective postoperative analgesia after abdominal and thoracic surgery. While offering a number of advantages compared with thoracic epidural analgesia, access to the paravertebral space using a classic approach is not always easily accomplished and/or possible. In this regard, continuous paravertebral blockade via a percutaneous intercostal approach may theoretically serve as an alternative approach to the paravertebral space. METHODS: One hundred ten patients undergoing major abdominal, thoracic, or retroperitoneal procedures had preoperative placement of unilateral or bilateral paravertebral catheter(s) via an intercostal approach. At a point 8 cm lateral to the midline a 5 cm, 18 G Tuohy needle was advanced with the needle tip angled 45 degrees cephalad and 60 degrees medial to the sagittal plane to come in contact with the lower third of the rib. The needle was {"}walked-off{"} the inferior border of the rib while maintaining its orientation and advanced a further 5 to 6 mm under the rib to lie in the subcostal groove. After injection of 5 mL ropivacaine 0.5{\%}, a catheter was advanced medially the estimated distance to the paravertebral space. Postoperatively 0.2{\%} ropivacaine was continuously infused at 10 mL/h in each catheter with hourly boluses of 5 mL available for breakthrough pain. RESULTS: Median pain scores averaged 2 on a scale of 0-10 and patient-controlled analgesia hydromorphone consumption averaged only 1.69 mg for the first 24 h postoperatively. There were no clinically significant complications of the technique. CONCLUSION: The intercostally placed paravertebral catheter provides postoperative analgesia after major surgery of the chest, abdomen, or retroperitoneum.",
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Intercostally placed paravertebral catheterization : An alternative approach to continuous paravertebral blockade. / Burns, David A.; Ben-David, Bruce; Chelly, Jacques E.; Greensmith, J. Eric.

In: Anesthesia and analgesia, Vol. 107, No. 1, 07.2008, p. 339-341.

Research output: Contribution to journalArticle

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T1 - Intercostally placed paravertebral catheterization

T2 - An alternative approach to continuous paravertebral blockade

AU - Burns, David A.

AU - Ben-David, Bruce

AU - Chelly, Jacques E.

AU - Greensmith, J. Eric

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N2 - BACKGROUND: Continuous paravertebral nerve blocks can provide effective postoperative analgesia after abdominal and thoracic surgery. While offering a number of advantages compared with thoracic epidural analgesia, access to the paravertebral space using a classic approach is not always easily accomplished and/or possible. In this regard, continuous paravertebral blockade via a percutaneous intercostal approach may theoretically serve as an alternative approach to the paravertebral space. METHODS: One hundred ten patients undergoing major abdominal, thoracic, or retroperitoneal procedures had preoperative placement of unilateral or bilateral paravertebral catheter(s) via an intercostal approach. At a point 8 cm lateral to the midline a 5 cm, 18 G Tuohy needle was advanced with the needle tip angled 45 degrees cephalad and 60 degrees medial to the sagittal plane to come in contact with the lower third of the rib. The needle was "walked-off" the inferior border of the rib while maintaining its orientation and advanced a further 5 to 6 mm under the rib to lie in the subcostal groove. After injection of 5 mL ropivacaine 0.5%, a catheter was advanced medially the estimated distance to the paravertebral space. Postoperatively 0.2% ropivacaine was continuously infused at 10 mL/h in each catheter with hourly boluses of 5 mL available for breakthrough pain. RESULTS: Median pain scores averaged 2 on a scale of 0-10 and patient-controlled analgesia hydromorphone consumption averaged only 1.69 mg for the first 24 h postoperatively. There were no clinically significant complications of the technique. CONCLUSION: The intercostally placed paravertebral catheter provides postoperative analgesia after major surgery of the chest, abdomen, or retroperitoneum.

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