Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ontario, Canada.
Department of Innovation in Medical Education, Division of Clinical and Functional Anatomy, Faculty of Medicine, University of Ottawa, Ontario, Canada.
Anaesthesia. 2017 Oct;72(10):1230-1236. doi: 10.1111/anae.14004. Epub 2017 Aug 1.
Current descriptions of thoracic paravertebral block techniques require the needle tip to be anterior to the superior costotransverse ligament. We hypothesised that an injection point midway between the posterior border of the transverse process and the pleura would result in spread to the paravertebral space. We completed bilateral injections of 5 ml methylene blue 0.2% midway between the posterior border of the transverse process and the pleura at T2, T4, T6, T8 and T10 in three unembalmed cadavers. The presence of methylene blue dye at the nerve root in the paravertebral space, the corresponding intercostal nerve and sympathetic chain at the level of injection, and at additional levels, was examined. We identified the superior costotransverse ligament, pleural displacement and spread to the erector spinae plane. We describe two case reports using this technique in patients. Our cadaver results and clinical cases demonstrate that, with the exception of cadaver 1, an injection point midway between the posterior border of the transverse process and pleura consistently achieved spread of dye at least to the paravertebral space at the level of injection, and frequently to adjacent levels. This may be a plausible explanation for the landmark technique's inability to reliably achieve a multilevel block. We describe a new ultrasound-guided technique for a single level paravertebral block.
目前对胸椎旁阻滞技术的描述要求针尖位于上肋横突韧带的前方。我们假设在横突后缘和胸膜之间的中点进行注射，将导致向椎旁间隙扩散。我们在三个未经防腐处理的尸体上，在 T2、T4、T6、T8 和 T10 处，在横突后缘和胸膜之间的中点，双侧注射 0.2%亚甲蓝 5 毫升。检查了在椎旁间隙神经根、注射部位相应的肋间神经和交感链以及其他水平的亚甲蓝染料的存在情况。我们确定了上肋横突韧带、胸膜移位和向竖脊肌平面的扩散。我们描述了两例使用该技术的患者病例。我们的尸体研究结果和临床病例表明，除了尸体 1 外，横突后缘和胸膜之间中点的注射点始终能将染料扩散到注射部位的椎旁间隙，并且经常扩散到相邻的水平。这可能是标志技术不能可靠地实现多水平阻滞的一个合理解释。我们描述了一种新的超声引导下用于单水平椎旁阻滞的技术。
