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