Skip to main content
SpringerLink
Log in

A single paravertebral injection via a needle vs. a catheter for the spreading to multiple intercostal levels: a randomized controlled trial

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

Thoracic paravertebral block (TPVB) provides a unilateral nerve block at multiple intercostal levels allowing injection of a local anesthetic into paravertebral space (PVS) via a needle or catheter. However, the most effective injection method remains unclear. This study compared the real-time spread of ropivacaine between two paravertebral injection methods using thoracoscopy.

Methods

Thirty-four patients scheduled for thoracoscopic surgery were randomly allocated into the Needle or Catheter groups, and performed transverse in-plane ultrasound-guided TPVB. The Needle group received 20 ml of 0.5% ropivacaine via a needle placed into the lateral edge of PVS; the Catheter group received the same dose of ropivacaine via a catheter inserted 5 cm into PVS. The primary outcome was the spreading pattern of ropivacaine in each group. The secondary outcome was intraoperative vasopressor requirement after paravertebral injection.

Results

In the Needle group, all cases showed ropivacaine spread to multiple intercostal levels, mainly across the ribs. Contrastingly, the Catheter group showed variable spreading patterns; multiple intercostal levels (n = 10) [across the ribs (n = 4), anterolateral aspect of the vertebral bodies (n = 6)] or unobservable spreading (no change; n = 7) (P = 0.007). Vasopressors were required in two and ten cases in the Needle and Catheter groups, respectively (P = 0.010).

Conclusion

Paravertebral injection via a needle typically resulted in spreading to multiple intercostal levels, especially across the ribs on the peripheral side of injection site, whereas injection via a catheter resulted in variable spreading patterns. Therefore, injections via needles are more stable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Yoshida T, Fujiwara T, Furutani K, Ohashi N, Baba H. Effects of ropivacaine concentration on the spread of sensory block produced by continuous thoracic paravertebral block: a prospective, randomised, controlled, double-blind study. Anaesthesia. 2014;69:231–9.

    Article  CAS  Google Scholar 

  2. Marhofer D, Marhofer P, Kettner SC, Fleischmann E, Prayer D, Schernthaner M, Lackner E, Willschke H, Schwetz P, Zeitlinger M. Magnetic resonance imaging analysis of the spread of local anesthetic solution after ultrasound-guided lateral thoracic paravertebral blockade: a volunteer study. Anesthesiology. 2013;118:1106–12.

    Article  CAS  Google Scholar 

  3. Cowie B, McGlade D, Ivanusic J, Barrington MJ. Ultrasound-guided thoracic paravertebral blockade: a cadaveric study. Anesth Analg. 2010;110:1735–9.

    Article  Google Scholar 

  4. Luyet C, Eichenberger U, Greif R, Vogt A, Szücs Farkas Z, Moriggl B. Ultrasound-guided paravertebral puncture and placement of catheters in human cadavers: an imaging study. Br J Anaesth. 2009;102:534–9.

    Article  CAS  Google Scholar 

  5. Luyet C, Herrmann G, Ross S, Vogt A, Greif R, Moriggl B, Eichenberger U. Ultrasound-guided thoracic paravertebral puncture and placement of catheters in human cadavers: where do catheters go? Br J Anaesth. 2011;106:246–54.

    Article  CAS  Google Scholar 

  6. Luyet C, Siegenthaler A, Szucs-Farkas Z, Hummel G, Eichenberger U, Vogt A. The location of paravertebral catheters placed using the landmark technique. Anaesthesia. 2012;67:1321–6.

    Article  CAS  Google Scholar 

  7. Naja MZ, Ziade MF, El Rajab M, El Tayara K, Lönnqvist PA. Varying anatomical injection points within the thoracic paravertebral space: effect on spread of solution and nerve blockade. Anaesthesia. 2004;59:459–63.

    Article  CAS  Google Scholar 

  8. Renes SH, Bruhn J, Gielen MJ, Scheffer GJ, van Geffen GJ. In-plane ultrasound-guided thoracic paravertebral block: a preliminary report of 36 cases with radiologic confirmation of catheter position. Reg Anesth Pain Med. 2010;35:212–6.

    Article  Google Scholar 

  9. Paraskeuopoulos T, Saranteas T, Kouladouros K, Krepi H, Nakou M, Kostopanagiotou G, Anagnostopoulou S. Thoracic paravertebral spread using two different ultrasound-guided intercostal injection techniques in human cadavers. Clin Anat. 2010;23:840–7.

    Article  Google Scholar 

  10. Fujii T, Shibata Y, Nishiwaki K. Observation of ultrasound-guided thoracic paravertebral block using thoracoscopy. Acta Anaesthesiol Taiwan. 2016;54:101–2.

    Article  Google Scholar 

  11. Shibata Y, Nishiwaki K. Ultrasound-guided intercostal approach to thoracic paravertebral block. Anesth Analg. 2009;109:996–7.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to express their profound gratitude to M. Nishimura (Department of Thoracic Surgery, Tosei General Hospital, Seto, Japan) for assistance with the thoracoscopy procedures for all the cases. The authors also thank Editage (https://www.editage.jp/) for providing professional editing services.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan

    Tasuku Fujii & Kimitoshi Nishiwaki

  2. Department of Surgical Center, Nagoya University Hospital, Nagoya, Japan

    Yasuyuki Shibata

  3. Department of Anesthesiology, Tosei General Hospital, Seto, Japan

    Yasutaka Ban & Akira Shitaokoshi

  4. Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Kunihiko Takahashi & Shigeyuki Matsui

Authors
  1. Tasuku Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuyuki Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasutaka Ban
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akira Shitaokoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kunihiko Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shigeyuki Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kimitoshi Nishiwaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimitoshi Nishiwaki.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Online Resource 1: Video 1. Injection via a Tuohy needle with spread across the ribs. A local anesthetic is injected into a thoracic paravertebral space via a Tuohy needle placed into the lateral edge of the paravertebral space. The local anesthetic mainly spreads into the multiple intercostal levels, especially across the ribs at the peripheral side of injection site. (MPG 6164 kb)

Online Resource 2: Video 2. Injection via a catheter and spreading at the anterolateral aspect of vertebral bodies. A local anesthetic is injected into a thoracic paravertebral space via a paravertebral catheter. The local anesthetic mainly spreads into the anterolateral aspect of vertebral bodies around the sympathetic trunk at multiple intercostal levels. (MPG 3390 kb)

Online Resource 3: Video 3. Injection via a catheter and spreading across the ribs. A local anesthetic is injected into a thoracic paravertebral space via a paravertebral catheter. The local anesthetic mainly spreads into the multiple intercostal spaces across the ribs. (MPG 3668 kb)

Online Resource 4: Video 4. Injection via a catheter and an unobservable spreading pattern. A local anesthetic is injected into a thoracic paravertebral space via a paravertebral catheter. The spreading of the local anesthetic is not identified under thoracoscopy. (MPG 2586 kb)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujii, T., Shibata, Y., Ban, Y. et al. A single paravertebral injection via a needle vs. a catheter for the spreading to multiple intercostal levels: a randomized controlled trial. J Anesth 34, 72–78 (2020). https://doi.org/10.1007/s00540-019-02713-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-019-02713-6

Keywords

Search

Navigation