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Thoracic Paravertebral Block: Influence of the Number of Injections
  1. Zoher M. Naja, M.D.,
  2. Mariam El-Rajab, M.D.,
  3. Mohamad A. Al-Tannir, M.PH.,
  4. Fouad M. Ziade, Ph.D.,
  5. Khalil Tayara, M.D.,
  6. Fadi Younes, M.D. and
  7. Per-Arne Lönnqvist, Ph.D.
  1. From the Anesthesia Department, Makassed General Hospital, Beirut, Lebanon
  2. Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
  3. Research Unit, Makassed General Hospital, Beirut, Lebanon
  4. Faculty of Public Health, Lebanese University, Beirut, Lebanon
  5. Radiology Department, Makassed General Hospital, Beirut, Lebanon
  6. 8Anesthesia & Intensive Care Department, Karolinska Astrid Lindgrens Children's Hospital, Stockholm, Sweden
  1. Reprint requests: Zouheir Naja M.D., Chairman of Anaesthesia Department, Makassed General Hospital, P.O. Box: 11-6301 Riad El-Solh 11072210, Beirut, Lebanon.. E-mail: zouhnaja{at}


Background and Objectives: The purpose of this study was to assess the radiographic and clinical distribution of 1 to 4 paravertebral injections by use of the same total volume of local anesthetic mixture.

Methods: Sixty-nine patients scheduled for surgical interventions suitable for bilateral PVB were included in the study and were randomly assigned to 1 of 3 treatment groups. Group 1 received 4 paravertebral injections on one side versus 1 injection on the contralateral side (23 patients), group 2 received 4 injections versus 2 injections (23 patients), and group 3 received 4 injections versus 3 injections (23 patients).

Results: Sixty-one patients were included in the final analysis, which resulted in 368 thoracic paravertebral injections. Overall, 97% of the patients had adequate loss of sensation within the targeted area at the side of 4 injections, compared with only 11% for the single injections. The average vertical spread of contrast was found to be significantly greater in the set of 4 injections, with mean (SD) 6.5 (2.01) dermatomes, compared with the single injection, with 3.0 (1.19) dermatomes (P < .05). The average vertical spread of contrast and complete absence of sensation were significantly greater in the set of 4 injections compared with the set of 2 and 3 injections (P < .05).

Conclusion: The main finding of the present study was that multiple paravertebral injections resulted in more reliable radiographic and clinical distribution compared with a single-injection technique.

  • Paravertebral block
  • Radiological
  • Sensation
  • Spread

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  • See Editorial page 189

    The work was funded by the Department of Anesthesia and Pain Medicine at Makassed General Hospital.