Radiology Medical News about Nerve Block Ultrasonography, Interventional Intercostal Muscles

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Ultrasound-Guided Paravertebral Block Using an Intercostal Approach
Anesthesia & Analgesia, 10/22/09

Ben–Ari A et al. – The authors describe an ultrasound–guided technique of continuous bilateral paravertebral block using an intercostal approach in 12 patients undergoing elective abdominal surgery. Postoperatively, each of the patient’s paravertebral catheters was bolused with 10 mL lidocaine (15 mg/mL), and each of the patient’s catheters was infused with 0.2% ropivacaine at 10 mL/h. Using a pinprick test, the median number of dermatomes blocked after the initial bolus was 5 (interquartile range, 4–6), and 23 of 24 catheters produced a local anesthetic block. The median verbal pain score on postoperative day 1 was 5.5 (interquartile range, 3.5–6), and median dose of IV hydromorphone consumed during the first 24 h after surgery was 1.9 mg (interquartile range, 0.7–5.05). All catheters were removed within 72 h after surgery.

Exclusive Author Commentary
Paul E. Bigeleisen, 10/23/09

We have finished analysis of preliminary data comparing an ultrasound guided paravertebral block in patients undergoing abdominal surgery. The primary end point was >3 dermatomes anesthetized bilaterally. We followed 13 patients who had bilateral paravertebral blocks (total of 26 paravertebral blocks). We showed that the ultrasound approach reliably blocked at least 3 dermatomes bilaterally. More work is needed to establish ultrasound guided paravertebral block as a reproducible technique to provide analgesia after abdominal surgery. Previous studies have focused on unilateral paravertebral block for thoracic surgery.

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