Article Text

Download PDFPDF
Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks: A Randomized Controlled Study Comparing Dermatomal Spread
  1. Vishal Uppal, FRCA*,
  2. Rakesh V. Sondekoppam, MD,
  3. Parvinder Sodhi, FRCPC*,
  4. David Johnston, FRCA and
  5. Sugantha Ganapathy, FRCPC§
  1. *Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia; †Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Alberta, Canada; ‡Department of Anesthesia, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom; and §Department of Anesthesia, Western University, London, Ontario, Canada
  1. correspondence: Vishal Uppal, FRCA, Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, 1276 South Park St, Halifax, Nova Scotia, Canada B3H 2Y9 (e-mail: v.uppal{at}


Background and Objectives The objective of this study was to investigate the extent of dermatomal spread following an ultrasound-guided thoracic paravertebral block (PVB) when equal volumes of local anesthetic are injected at 1 versus 5 vertebral levels.

Methods Seventy patients undergoing a unilateral mastectomy were randomized to receive either single or multiple injections of a PVB under real-time ultrasound guidance using a parasagittal approach. The patients in the single-injection group received a PVB at T3–T4 level with 25 mL of 0.5% ropivacaine and 4 subcutaneous sham injections. Patients in the multiple-injection group received 5 injections of a PVB from T1 to T5 level. Five milliliters of 0.5% ropivacaine was injected at each level. Evaluation of the sensory block was carried out 20 minutes following the completion of the PVB.

Results The median (interquartile range) dermatomal spread was not significantly different for the single-injection group (5 [4-6]) compared with the multiple-injection group (5 [5-6]), with a median difference of 0 segments (95% confidence interval, −1 to 0 segments; P = 0.22). The median time to performance of the single-injection PVB was shorter compared with the multiple-injection group (10 minutes), with a mean difference of −4 minutes (95% confidence interval, −6 to −3 minutes; P < 0.001).

Conclusions An ultrasound-guided single-injection PVB provides equivalent dermatomal spread and duration of analgesia compared with a multiple-injection PVB. The single-injection technique takes less time to perform and hence may be preferred over a multiple-injection technique.

The trial was registered prospectively at (NCT02852421) on July 15, 2016.

Statistics from


  • This study is attributed to the Department of Anesthesia, Western University, London, Ontario, Canada.

    This research was sponsored by the Lawson Health Research Institute. No external funding was obtained for this study.

    The abstract of this report was presented as a moderated poster at the 41st Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine, March 31 to April 2, 2016, New Orleans, Louisiana.

    The authors declare no conflict of interest.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.