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Anaesthesia Critical Care & Pain Medicine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 25 avril 2019
Doi : 10.1016/j.accpm.2019.04.003
Thoracic paravertebral block: comparison of different approaches and techniques. A study on 27 human cadavers
 

Laura Ruscio a, b, , Régis Renard b, Cédric Lebacle b, c, Paul Zetlaoui a, Dan Benhamou a, b, Thomas Bessede b, c
a Département d’anesthésie-réanimation, Hôpital Bicêtre, groupe hospitalier et faculté de médecine Paris-Sud (AP–HP), 94270 Le Kremlin-Bicêtre France 
b UMR 1195, Université Paris Sud, Inserm, Université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France 
c Département d’urologie, Hôpitaux Universitaires Paris-Sud, AP–HP, 94270 Le Kremlin-Bicêtre, France 

Corresponding author at: Département d’anesthésie-réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud (AP–HP), 94275 Le Kremlin-Bicêtre France.Département d’anesthésie-réanimationHôpital Bicêtre, Hôpitaux Universitaires Paris-Sud (AP–HP)Le Kremlin-Bicêtre94275France
Abstract
Background and objectives

The success rate and spread of thoracic paravertebral block (TPVB) are variable and difficult to predict. It is now recommended that an ultrasound guidance technique should replace the traditional landmark technique. The objective was to compare anatomical outcomes of both techniques on cadavers.

Methods

A landmark technique (loss of resistance technique [LOR]) and a USG technique (three approaches: sagittal, transversal in-plane, transverse out-of-plane) were performed on 27 thawed non-embalmed cadavers. Each of the four approaches was performed in each body (T3–T5 and T9-T11 × right and left). A coloured solution (13 mL, saline 0.9%) was injected in the targeted thoracic paravertebral space (TPVS). A successful thoracic paravertebral injection (TPVI) was defined by the presence of dye in at least one TPVS during anatomical dissection.

Results

In 104 TPVIs analysed, the overall success rate was 78%. Factors associated with success were: USG versus LOR technique (85% vs. 52%, P  < 0.0007), sagittal versus both transversal approaches (93%/81%/83%, P  < 0.0007) and right side (86% vs. 66%). The median spread was 2 TPVS (min – max 1–5) with a median cephalad-caudal spread of 5 cm (min - max 1-18). By multivariate analysis, the sagittal approach was an independent factor of success (OR 2.75). Dye spread and pleural entry were influenced by neither the approach nor the site of injection.

Conclusions

Paravertebral spread of TPVI is variable. USG technique has higher anatomical success rates than the LOR technique, the sagittal USG approach being the most successful.

The full text of this article is available in PDF format.

Keywords : Thoracic paravertebral block, Cadaveric study, Ultrasound-guided regional anaesthesia, Spread




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