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Transverse vs. parasagittal in-plane approaches in ultrasound-guided paravertebral block using a microconvex probe: A randomised controlled trial.

Abstract：

BACKGROUND:Several approaches have been proposed for ultrasound-guided thoracic paravertebral block, but the best approach remains unclear. OBJECTIVE:We compared two ultrasound-guided in-plane approaches using a microconvex probe, transverse and parasagittal. We assessed whether either approach would facilitate successful catheter placement in the paravertebral space. DESIGN:Randomised controlled trial. SETTING:University hospital, July 2015 to March 2016. PATIENTS:Sixty patients scheduled to undergo thoracotomy were randomly allocated into two groups. INTERVENTIONS:A microconvex probe was placed transversely between adjacent ribs (transverse) or sagittally between adjacent transverse processes (parasagittal). When the Tuohy needle reached the paravertebral space, a catheter was inserted to a depth of 4 cm. Then, 0.5-ml radiocontrast was injected through the catheter under fluoroscopy. MAIN OUTCOME MEASURES:The primary outcome was successful catheter placement in the paravertebral space; secondary outcomes were 0 to 100 mm visual analogue scale pain score and morphine consumption in the first 24 h. RESULTS:All patients received the allocated paravertebral block. Correct catheter placement occurred in 23 (77%) and 24 patients (80%) using the transverse (n=30) and parasagittal approaches (n=30), respectively (P = 1.00). Five patients were excluded due to changes in surgical procedure. Postoperative pain, represented by median [IQR] visual analogue scale score, was 19.5 [12 to 25] at rest and 55 [44 to 77] on movement with the transverse approach (n=28) vs. 22 [12 to 33.5] at rest and 59 [41.5 to 75] on movement with the parasagittal approach (n=27) (P = 0.57 at rest, P = 0.76 on movement). Median morphine consumption was 11.5 [5 to 21] and 11 [5 to 18] mg in the transverse and parasagittal approaches, respectively (P = 0.99). CONCLUSION:There were no clinically significant differences between approaches for continuous ultrasound-guided thoracic paravertebral block using a microconvex probe, and both approaches achieved a high rate of correct catheter placement. TRIAL REGISTRATION:UMIN Clinical Trials Registry identifier: UMIN000015988.

journal_name

Eur J Anaesthesiol

journal_title

European journal of anaesthesiology

authors

Fujii T,Shibata Y,Shinya S,Nishiwaki K

doi

10.1097/EJA.0000000000001223

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

752-757

issue

eissn

0265-0215

issn

1365-2346

journal_volume

pub_type

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Transverse vs. parasagittal in-plane approaches in ultrasound-guided paravertebral block using a microconvex probe: A randomised controlled trial.