Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Br J Anaesth. 2010 Oct;105(4):526-32. doi: 10.1093/bja/aeq206. Epub 2010 Aug 3.
Paravertebral blockade (PVB) is a regional anaesthetic technique with a large number of indications. PVB is usually performed with landmark-based techniques or methods that rely on pressure differences between the extra- and intraparavertebral space. This consecutive case series was designed to describe the ultrasound appearance of the lateral thoracic paravertebral space (PVS) and develop an ultrasound-guided method for PVB.
The PVS of 20 women undergoing breast cancer surgery was investigated with a high-frequency linear ultrasound transducer in the sitting position. After identification of the transverse process, internal intercostal membrane (IIM), and pleura at the T3 and T6 levels, the depths of the IIM and pleura, and the sagittal diameter of the PVS were determined. An out-of-plane needle guidance technique was used to perform the PVB with ropivacaine 0.75% (12 ml) at both levels. Successful blockade was determined by the ability to perform surgery under light general anaesthesia without opioids.
Appropriate ultrasound identification of the IIM, transverse processes, and pleura was possible in all cases. Correct placement of the tip of the needle in the PVS resulted in successful PVB. No correlations of morphometric data with ultrasound measurements of the PVS were detected.
After ultrasound identification of the boundaries of the lateral PVS, an out-of-plane needle guidance technique facilitated successful PVB. There were no clinically relevant correlations between morphometric data and ultrasound measurements.
椎旁阻滞（PVB）是一种具有多种适应证的区域麻醉技术。PVB 通常采用基于体表标志的技术或依赖于椎旁间隙内外压力差的方法进行。本连续病例系列旨在描述侧胸椎旁间隙（PVS）的超声表现，并开发一种超声引导下的 PVB 方法。
在 20 名接受乳腺癌手术的女性中，采用高频线性超声探头在坐位下对 PVS 进行研究。在 T3 和 T6 水平识别出横突、肋间内肌膜（IIM）和胸膜后，测量 IIM 和胸膜的深度以及 PVS 的矢状直径。采用平面外针引导技术，在两个水平分别用 0.75%罗哌卡因（12ml）进行 PVB。手术在无阿片类药物的轻度全身麻醉下进行，以确定阻滞成功。
在所有病例中，均可对 IIM、横突和胸膜进行适当的超声识别。针尖正确置于 PVS 内可成功进行 PVB。未发现形态计量数据与 PVS 的超声测量之间存在相关性。
在超声识别侧胸 PVS 的边界后，采用平面外针引导技术可促进成功的 PVB。形态计量数据与超声测量之间无临床相关相关性。
