The Placement of Needle and Volume of Local Anesthetics for Thoracic Paravertebral Block (T2, T3) in Korean Adults

Yoon, Keon Jung; Lee, Sang Mook; Yun, You Ok

Abstract

BACKGROUND
Thoracic paravertebral block (TPVB) is useful in the management of the unilateral acute and chronic pain originating from the arm, chest and abdomen. TPVB has technical ease and safety, and allows blind practice in the out-patient clinic. This study aimed to evaluate the mean depths from the skin to the 2nd and 3rd thoracic paravertebral spaces (T2 & T3 TPVS), the mean distance from the spinous process to the needle insertion point and the mean blocked dermatome by local anesthetics volume. METHODS: Of the 32 patients investigated, 19 were suffering from unilateral pain, according to the complex regional pain syndrome types I and II (CRPS I, CRPS II), and post herpetic neuralgia (PHN) in an upper extremity or the upper chest region. The other 13 patients had been expected to undergo a thoracotomy. TPVB was performed with a fluoroscopic C-arm, at the 2nd and 3rd thoracic vertebral levels. The depth from the skin to the thoracic paravertebral space (TPVS), the distance from spinous process to the inserted point and the range of blocked dermatomes by local anesthetics volume. RESULTS: The mean depth from skin to the TPVS (T2, T3), the mean distance from the spinous process to the insert point and the mean blocked dermatome were 4.7 +/- 0.62 and 2.4 +/- 0.53 cm, and 5.1+/- 0.55 dermatomes/7 ml, respectively. CONCLUSIONS: The mean depth from the skin to the TPVS (T2, T3) and the distance from the spinous process to the inserted site may be a guide for TPVB in a pain clinic, without C-arm guidance. The mean blocked dermatome is clinically useful for the injection of local anesthetics for TPVB in pain management.