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Abstract
Background and aims The use of paravertebral block (PVB) has served an important role in acute pain control and enhanced recovery for numerous types of surgeries. Fundamental to its safe application is an in-depth understanding of anatomical landmarks, proper approach and the potential dangers. We portray a case report of a 61-year-old woman with lung adenocarcinoma and severe scoliosis who underwent a right-sided robotic-assisted thoracoscopy with upper lobectomy and mediastinal lymphadenectomy with pre-operative PVB catheter placement for perioperative pain control.
Methods After providing consent, the patient was placed in the sitting position and pre-scanned using ultrasound for identification of the T5/T6 paravertebral space (PS).The first clinician using ultrasound re-identified our target PS after prepping the skin. A second clinician using an 18G Tuohy needle accessed the PS at 5 cm using live ultrasound. A soft-tip catheter was left in place at 10 cm. A total of 5cc of 0.5% Ropivicane was injected through the catheter once firmly secured in place. Authorization to photograph/video record the patient was obtained.
Results See figures 1, 2, and 3.
Chest x-ray showing drastic curvature of thoracolumbar spine.
Ultrasound image illustrating needle pass into the PS
Right-sided PVB catheter 7.5 cm lateral from midline in relation to thoracoscopic port sites.
The patient was discharged POD#4 with her chest tube removed pain free.
Conclusions PVB has been shown to be an excellent evidence-based regional technique to contribute to both anesthesia and analgesia. Paramount to its application is the proper approach, especially when encountering anatomical variations. With an appropriate systematic approach and identification of vital structures, PVB catheter placement may be utilized in severe scoliosis with successful post-operative pain control.