This retrospective study aims to assess the impact of paravertebral catheter insertion depth on the final anatomical position of the catheter tip. Another objective is to characterize the contrast distribution patterns through paravertebral catheters verified to reside within the thoracic paravertebral space.
The effectiveness of a continuous thoracic paravertebral block depends on optimal catheter tip placement and adequate distribution of local anesthetic. This study evaluated the relation between the catheter insertion depth and the final anatomical position of the catheter tip. Additionally, contrast distribution patterns were assessed for catheter tips residing within the thoracic paravertebral space. Ultrasound-guided paravertebral catheters were inserted at multiple catheter insertion depths beyond the needle tip in 31 patients undergoing breast surgery. Post-mobilization computed tomography (CT) imaging was used to determine the catheter tip location. Catheter tips with a confirmed position in the paravertebral space were further analyzed for contrast distribution.
Study Type
OBSERVATIONAL
Enrollment
31
Clinique Sainte-Anne Saint Rémi
Brussels, Belgium
Paravertebral catheter tip position
Postoperatively, patients underwent CT scanning with 0.1 mL of contrast dye (Iomeron, iomeprol, Bracco) to precisely determine the catheter tip position and permit adjustments if needed. Two anesthesiologists independently evaluated the CT images with regards to the insertion level, depth relative to the lamina, and catheter tip location in relation to key anatomical structures. Tip locations were defined as paravertebral or non-paravertebral. Different locations were identified for both the paravertebral and the non-paravertebral spaces. Paravertebral space locations: Anterior paravertebral: Between the anterior and posterior borders of the vertebral corpus. Periforaminal paravertebral: Within 1 cm of the foramen. Posterior paravertebral: From the foramen to the articular process. Non-paravertebral locations: Prevertebral: Anterior to the vertebral body. Intramuscular: Posterior to the lamina within the erector spinae muscles. Epidural and Pleural: Standard anatomical definition.
Time frame: 1 Day of breast surgery
Paravertebral contrast distribution
Postoperatively, patients received a CT scan with 0.1 mL of contrast dye (Iomeron, iomeprol, Bracco) to evaluate the catheter tip position. Only patients with a catheter in the paravertebral space received a second bolus of 1 mL contrast dye and 9 mL saline 0.9%. Two anesthesiologists independently evaluated the catheter tip position across the different anatomical areas close to the paravertebral space. Additionally, the contrast distribution was assessed in the anteroposterior and craniocaudal direction of catheters with a paravertebral catheter tip position. Paravertebral space locations: Anterior paravertebral: Between the anterior and posterior borders of the vertebral corpus. Posterior paravertebral: From the foramen to the articular process. Non-paravertebral locations: Prevertebral: Anterior to the vertebral body. Intramuscular: Posterior to the lamina within the erector spinae muscles. Epidural, Intercostal and Pleural: Standard anatomical definitions applied.
Time frame: 1 Day of breast surgery
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