| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
From the Department of Anesthesiology,* University of Pittsburgh Medical Center and UPMC Shadyside-Presbyterian Hospital Pittsburgh, Pennsylvania, USA.
Address correspondence to: Dr. Jacques E. Chelly, UPMC Shadyside Hospital, Department of Anesthesiology, Suite M104 (Posner Pain Center), 5230 Centre Avenue, Pittsburgh, PA 15232, USA. Phone: 412-623-6904; Fax: 412-623-4188; E-mail: chelje{at}anes.upmc.edu
Purpose: Predicting the depth of needle insertion for paravertebral nerve blocks is currently based on patients’ anthropometric characteristics, and the block level. Although preliminary studies report relationships between paravertebral depth and the body mass index (BMI), the number of observations, to date, are inadequate to formulate reliable conclusions.This study was designed to determine which factors may predict the distance between the skin and paravertebral space, for patients undergoing paravertebral nerve block procedures.
Methods: After review of peripheral nerve block procedure records, 559 surgical patients who underwent a total of 1,318 thoracic paravertebral nerve blocks for postoperative pain control, were included in the study. The patients’ gender, age, weight, height, BMI, thoracic level of the performed block, and depth of the needle insertion were analyzed, using stepwise multiple regression models.
Results: With the exception of T5, a linear relationship was established between paravertebral depth and thoracic level, with depth increasing at inferior thoracic levels. The greatest depth was observed in younger patients with higher BMIs. Depth was more variable, and more strongly correlated with age and weight, at levels T4 throughT8, compared to levels T9 through T12. Age had no influence on depth between T9 and T12. In patients who underwent multiple blocks, awareness of depth of one paravertebral space allowed more accurate prediction of the depth of the other paravertebral spaces.
Conclusion: Age, weight and the thoracic level influence the depth of the paravertebral space between spinal levels T4 and T8, while only the thoracic level and body weight are implicated between T9 and T12.
1 Eason MJ, Wyatt R. Paravertebral thoracic block – a reappraisal. Anaesthesia 1979; 34: 638–42.[Medline]
2 Sabanathan S, Richardson J, Mearns AJ. Management of pain in thoracic surgery. Br J Hosp Med 1993; 50: 114–20.[Medline]
3 Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E. Single-injection paravertebral block compared to general anesthesia in breast surgery. Acta Anaesthesiol Scand 1999; 43: 770–4.[Medline]
4 Naja Z, Ziade MF, Lonnqvist PA. Bilateral paravertebral somatic nerve block for ventral hernia repair. Eur J Anaesthesiol 2002; 19: 197–202.[Medline]
5 Kirvela O, Antila H. Thoracic paravertebral block in chronic postoperative pain. Reg Anesth 1992; 17: 348–50.[Medline]
6 Coveney E, Weltz CR, Greengrass R, et al. Use of paravertebral block anesthesia in the surgical management of breast cancer: experience in 156 cases. Ann Surg 1998; 227: 496–501.[Medline]
7 Tenicela R, Pollan SB. Paravertebral-peridural block technique: a unilateral thoracic block. Clin J Pain 1990; 6: 227–34.[Medline]
8 Richardson J, Lonnqvist PA. Thoracic paravertebral block. Br J Anaesth 1998; 81: 230–8.
9 Saito T, Gallagher ET, Yamada K, Tanuma K, Ogawa R. Broad unilateral analgesia. Reg Anesth 1994; 19: 360–1.[Medline]
10 Saito T, Gallagher ET, Cutler S, et al. Extended unilateral anesthesia. New technique or paravertebral anesthesia? Reg Anesth 1996; 21: 304–7.[Medline]
11 Ben-David B, Swanson J, Nelson JB, Chelly JE. Multimodal analgesia for radical prostatectomy provides better analgesia and shortens hospital stay. J Clin Anesth 2007; 19: 264–8.[Medline]
12 Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence of metastasis? Anesthesiology 2006; 105: 660–4.[Medline]
13 Pusch F, Wildling E, Klimscha W, Weinstabl C. Sonographic measurement of needle insertion depth in paravertebral blocks in women. Br J Anaesth 2000; 85: 841–3.
14 Lonnqvist PA, Hesser U. Radiological and clinical distribution of thoracic paravertebral blockade in infants and children. Pediatr Anaesth 1992; 47: 1051–2.
15 Lonnqvist PA, MacKenzie J, Soni AK, Conacher ID. Paravertebral blockade. Failure rate and complications. Anaesthesia 1995; 50: 813–5.[Medline]
16 Richardson J, Sabanathan S. Thoracic paravertebral analgesia. Acta Anaesthesiol Scand 1995; 39: 1005–15.[Medline]
17 Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001; 95: 771–80.[Medline]
18 Naja MZ, Gustafsson AC, Ziade MF, et al. Distance between the skin and the thoracic paravertebral space. Anaesthesia 2005; 60: 680–4.[Medline]
19 Naja MZ, Ziade MF, El Rajab M, El Tayara, Lonnqvist PA. Varying anatomical injection points within the thoracic paravertebral space: effect on spray of solution of nerve blockade. Anaesthesia 2004; 59: 459–63.[Medline]
20 Casati A, Alessandrini P, Nuzzi M, et al. A prospective, randomized, blinded comparison between continuous thoracic paravertebral and epidural infusion of 0.2% ropivacaine after lung resection surgery. Eur J Anaesthesiol 2006; 23: 999–1004.[Medline]
21 Williams RL. A note on robust variance estimation for cluster-correlated data. Biometrics 2000; 56: 645–6.[Medline]
22 Jarque CM. "Efficient tests for normality, homoscedasticity and serial independence of regression residuals". Econ Lett 1980; 6: 255–9.
23 Picard RR, Cook RD. Cross-validation of regression models. Journal of the American Statistical Association 1984; 79: 575–83.[Medline]
24 Berry WD, Feldman S. Multiple Regression in Practice. CA: Sage; 1985: 37–50.
25 Luketich JD, Land SR, Sullivan EA, et al. Thoracic epidural versus intercostal nerve catheter plus patient-controlled analgesia: a randomized study. Ann Thorac Surg 2005; 79: 1845–9.
26 Marret E, Bazelly B, Taylor G, et al. Paravertebral block with ropivacaine 0.5% versus systemic analgesia for pain relief after thoracotomy. Ann Thorac Surg 2005; 79: 2109–13.
27 Richardson J, Cheema SPS, Hawkins J, Sabanathan S. Thoracic paravertebral space location: A new method using pressure measurement. Anaesthesia 1996; 51: 137–9.[Medline]
28 Boezaart AP, Raw RM. Continuous thoracic paravertebral block for major breast surgery. Reg Anesth Pain Med 2006; 31: 470–6.[Medline]
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
