Skip Navigation


BJA Advance Access originally published online on February 24, 2009
British Journal of Anaesthesia 2009 102(4):534-539; doi:10.1093/bja/aep015
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
102/4/534    most recent
aep015v1
Right arrow E-Letters: Submit a response to the article
Right arrow E-letters: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Luyet, C.
Right arrow Articles by Moriggl, B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Luyet, C.
Right arrow Articles by Moriggl, B.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Ultrasound-guided paravertebral puncture and placement of catheters in human cadavers: an imaging study

C. Luyet1, U. Eichenberger1,*, R. Greif1, A. Vogt1, Z. Szücs Farkas2 and B. Moriggl3

1 Department of Anaesthesiology and Pain Therapy
2 Department of Radiology, Inselspital, University Hospital of Bern, and University of Bern, CH-3010 Bern, Switzerland
3 Department of Anatomy, Histology, and Embryology, Innsbruck Medical University, Innsbruck, Austria

* Corresponding author. E-mail: urs.eichenberger{at}insel.ch

Background: During paravertebral block, the anterolateral limit of the paravertebral space, which consists of the pleura, should preferably not be perforated. Also it is possible that, during the block, the constant superior costotransverse ligament can be missed in the loss-of-resistance technique. We therefore aimed to develop a new technique for an ultrasound-guided puncture of the paravertebral space.

Methods: We performed 20 punctures and catheter placements in 10 human cadavers. A sonographic view showing the pleura and the superior costotransverse ligament was obtained with a slightly oblique scan using a curved array transducer. After inline approach, injection of 10 ml normal saline confirmed the correct position of the needle tip, distended the space, and enabled catheter insertion. The spread of contrast dye injected through the catheters was assessed by CT scans.

Results: The superior costotransverse ligament and the paravertebral space were easy to identify. The needle tip reached the paravertebral space without problems under visualization. In contrast, the introduction of the catheter was difficult. The CT scan revealed a correct paravertebral spread of contrast in 11 cases. Out of the remaining, one catheter was found in the pleural space, in six cases there was an epidural, and in two cases there was a prevertebral spread of contrast dye.

Conclusions: We successfully developed a technique for an accurate ultrasound-guided puncture of the paravertebral space. We also showed that when a catheter is introduced through the needle with the tip lying in the paravertebral space, there is a high probability of catheter misplacement into the epidural, mediastinal, or pleural spaces.

Keywords: anaesthetic techniques, regional, paravertebral; analgesic techniques; anatomy, chest wall; monitoring, ultrasound; regional anaesthesia


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


E-letters:

Read all E-letters

Ultrasound for paravertebral block
Sean Q M Tighe
British Journal of Anaesthesia, 7 May 2009 [Full text]
Frequent epidural spread can be prevented when performing an ultrasound guided approach to the paravertebral space.
Jacques E. Chelly, MD, PhD, MBA, et al.
British Journal of Anaesthesia, 16 Jun 2009 [Full text]

Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.