Fujii T, Shibata Y, Ban Y, Shitaokoshi A, Nishiwaki K
Department of Anesthesiology, Nagoya University Hospital, Nagoya, Japan.
Department of Surgical Center, Nagoya University Hospital, Nagoya, Japan.
Asian J Anesthesiol. 2017 Mar;55(1):24-25. doi: 10.1016/j.aja.2017.05.004. Epub 2017 Jun 2.
Thoracic paravertebral block (TPVB) is an efficient alternative to epidural anesthesia. The location of a catheter within the thoracic paravertebral space (TPVS) has been examined in the human cadaver studies, but it is unclear how it goes into the TPVS during catheterization. In this report, thoracoscopy was used to observe the thoracic cavity in real-time during a parasagittal in-plane approach of ultrasound-guided TPVB. During thoracoscopy, we observed whether a paravertebral catheter could be advanced caudally beyond the ribs into the neighboring TPVS. Our result demonstrated that the catheter was difficult to be advanced beyond the ribs and confined within the same level of TPVS as where it was inserted. In the previous thoracoscopic observation of the paravertebral spread, we assumed that the local anesthetic acts most strongly at the intercostal level of the injection. Therefore, we recommend to insert the catheter for TPVB at the level corresponding to the incision site of thoracotomy.
胸段椎旁阻滞（TPVB）是硬膜外麻醉的一种有效替代方法。人体尸体研究已对导管在胸段椎旁间隙（TPVS）内的位置进行了检查，但尚不清楚在置管过程中导管是如何进入TPVS的。在本报告中，在超声引导下TPVB的矢状旁平面入路过程中，使用胸腔镜实时观察胸腔。在胸腔镜检查过程中，我们观察了椎旁导管是否可以向尾侧推进至肋骨以下进入相邻的TPVS。我们的结果表明，导管难以推进至肋骨以下，而是局限于与插入部位相同水平的TPVS内。在先前对椎旁扩散的胸腔镜观察中，我们假设局部麻醉药在注射的肋间水平作用最强。因此，我们建议在与开胸手术切口部位相对应的水平插入TPVB导管。
