Advertisement

Surgical and Radiologic Anatomy

, Volume 21, Issue 6, pp 359–363 | Cite as

Anatomical bases for paravertebral an esthetic block: fluid communication between the thoracic and lumbar paravertebral regions

  • T. Saito
  • S. Den
  • K. Tanuma
  • Y. Tanuma
  • E. Carney
  • C. Carlsson
Anatomic Bases Of Medical, Radiological And Surgical Techniques

Summary

An injection of a local anesthetics in the paravertebral region produces an analgesic field on the same side of the body, a paravertebral block. One point in question about this block is whether the local anesthetic spreads from the thoracic to the lumbar level of the paravertebral region. The purpose of this study was to find how the anesthetic fluid traveled to the lumbar paravertebral region, if at all. Twelve cadavers were used in this study. 15 ml of crimson dye was injected into the paravertebral region at the 11th thoracic level. The viscerae were removed so that we could examine the dye spread. While the crimson dye spread in the endothoracic fascia posterior to the parietal pleura, it also spread downward in the fascia mostly along the splanchnic nerves. At the upper surface of the diaphragm the dye spread laterally in the fascia, and entered the abdominal cavity through the medial and lateral arcuate ligaments. In the abdominal cavity, the dye was found to have spread so widely in the transversalis fascia that the subcostal, iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous and femoral nerves were involved. We concluded that the dye in the thoracic paravertebral region can enter the abdominal cavity through the medial and lateral arcuate ligaments. This study explained possible fluid communication between the thoracic and lumbar paravertebral regions and confirmed our former clinical observations. The result is important for the future clinical application of paravertebral anesthesia.

Key words

Lumbar plexus Intercostal nerves Anesthesia regional Paravertebral block 

Communication perméable aux liquides entre les régions paravertébrales thoracique et lombaire

Résumé

L'injection d'un anesthésique local dans la région paravertébrales entraîne une analgésie unilatérale localisée (bloc paravertébral). On pouvait se demander si l'anesthésique local diffusait du niveau thoracique au niveau lombaire de la région paravertébrale. Le but de cette étude était de définir comment le liquide anesthésique gagnait la région paravertébrale lombaire, s'il le faisait. 12 cadavres ont été utilisés dans cette étude. 15 mm de colorant rouge ont été injectés dans la région paravertébrale des cadavres au niveau de la 11ème vertèbre thoracique. Les viscères ont ensuite été enlevés pour permettre l'examen de la diffusion du colorant. Le colorant diffusait dans le fascia endothoracique en arrière de la plèvre pariétale, puis vers le bas à l'intérieur du fascia, principalement le long des nerfs splanchniques. A la face supérieure du diaphragme, il diffusait latéralement dans le fascia, et pénétrait dans la cavité abdominale au-dessous des ligaments arqués médial et latéral. Dans la cavité abdominale, le colorant diffusait largement dans le fascia transversalis de telle sorte qu'il atteignait les nerfs subcostal, ilio-hypogastrique, ilio-inguinal, génito-fémoral, cutané latéral de la cuisse, et fémoral. Nous en avons conclu que le colorant pouvait passer de la région paravertébrale thoracique dans la cavité abdominale au-dessous des ligaments arqués médial et latéral. Cette étude montre la communication possible des liquides entre les régions paravertébrales thoracique et lombaire, et corrobore nos observations cliniques préalables. Le résultat en est important pour l'utilisation clinique ultérieure des blocs paravertébraux.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Atkinson RS, Rushman GB, Lee JA (1982) A synopsis of anaesthesia. 9th ed. John Wright & Sons, Bristol, England pp 689–690Google Scholar
  2. 2.
    Bonica JJ (1953) Thoracic paravertebral block. The management of pain, 2nd ed. Lea & Febiger, Philadelphia, USA, pp 1910–1911Google Scholar
  3. 3.
    Cheema SPS, Ilsley D, Richardson J, Sabanathan S (1995) A thermographic study of paravertebral analgesia. Anaesthesia 50:118–121Google Scholar
  4. 4.
    Clemente CD (1985) Gray's Anatomy, 30th American ed, Lea & Febiger, Philadelphia, USA, pp 475Google Scholar
  5. 5.
    Clive J. (1963) Local analgesia. Little, Brown & Co., Boston, USA, pp 50–57Google Scholar
  6. 6.
    Eason MJ, Wyatt R (1979) Paravertebral thoracic block— a reappraisal. Anaesthesia 34:634–642Google Scholar
  7. 7.
    Eisler P (1912) Die Muskeln des Stammes, Gustav Fischer, Jena, Germany, pp518–544Google Scholar
  8. 8.
    Gieseck K, Hamberger B, Järnberg P-O, Klingstedt C (1988) Paravertebral block during cholecystectomy: effects on circulatory and hormonal responses. Br J of Anaesth 61:652–656Google Scholar
  9. 9.
    Johansson A, Renck H, Aspelin P, Jacobsen H (1985) Multiple intercostal block by a single injection? Acta Anaesthesiol Scand 29:524–528Google Scholar
  10. 10.
    Lönnqvist PA (1992) Continuous paravertebral block in children-initial experience. Anaesthesia 47:607–609Google Scholar
  11. 11.
    Lönnqvist PA, Hildingsson U (1992) The caudal boundary of the thoracic paravertebral space. Anaesthesia 47:1051–1052Google Scholar
  12. 12.
    MacIntosh R, Bryce-Smith R (1962) Local analgesia and abdominal surgery. 2nd ed. E & S Livingstone, Edinburgh pp 26–32.Google Scholar
  13. 13.
    MacIntosh RR, Mushin WM (1947) Observations on the epidural space. Anesthesia 2:100–104Google Scholar
  14. 14.
    Nunn JJ, Slavin G (1980) Posterior intercostal nerve block for pain relief after cholecystectomy: anatomical basis and efficacy. Br J Anaesth 52: 253–259Google Scholar
  15. 15.
    Perlemuter L, Waligora J (1976) Cahiers d'anatomie, 4e ed, Masson, Paris, France, pp 169Google Scholar
  16. 16.
    Renck H (1995) Time for revivification of paravertebral blocks? Acta Anaesthesiol Scand 39: 1003–1004Google Scholar
  17. 17.
    Richardson J, Lönnqvist PA (1998) Thoracic paravertebral block. Br J Anaesth 81: 230–238Google Scholar
  18. 18.
    Rieske JM (1959) Terminal obstetrical anesthesia by means of lumbar sympathetic paravertebral block. Am J Obstet Gynecol 78: 441–444Google Scholar
  19. 19.
    Saito T, Gallagher ET, Cutler S, K Tanuma, K Yamada, N Saito, K Maruyama, C Carlsson (1996) Extended unilateral anesthesia: new technique or paravertebral anesthesia? Reg Anesth 21: 304–307Google Scholar
  20. 20.
    Saito T, Gallagher ET, Yamada K, Tanuma K, Ogawa R (1994) Broad unilateral analgesia. Reg Anesth 19: 360–361Google Scholar
  21. 21.
    Tenicela R, Pollan SB (1990) Paravertebral-peridural block technique: a unilateral thoracic block. Clin J Pain 6: 227–234Google Scholar
  22. 22.
    Toldt C, Hochstetter F (1979) Anatomischer Atlas, Band 2, Urban & Schwarzenberg, München, Germany, p 107Google Scholar

Copyright information

© Springer-Verlag 1999

Authors and Affiliations

  • T. Saito
    • 1
  • S. Den
    • 1
  • K. Tanuma
    • 2
  • Y. Tanuma
    • 3
  • E. Carney
    • 1
  • C. Carlsson
    • 4
  1. 1.Department of AnesthesiologyThe National Cancer Center HospitalKanagawaJapan
  2. 2.Department of AnatomyNippon Medical SchoolTokyoJapan
  3. 3.Department of AnatomyTeikyo UniversityTokyoJapan
  4. 4.Department of AnesthesiologyLund UniversityMalmöSweden

Personalised recommendations