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Distribution of injectate administered through a catheter inserted by three different approaches to ultrasound-guided thoracic paravertebral block: a prospective observational study
  1. Sivaporn Termpornlert1,2,
  2. Shinichi Sakura1,
  3. Yuki Aoyama1,
  4. Aumjit Wittayapairoj1,3,
  5. Koji Kishimoto4 and
  6. Yoji Saito1
  1. 1 Anesthesiology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
  2. 2 Anesthesiology, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
  3. 3 Anesthesiology, Khon Kaen University Faculty of Medicine, Khon Kaen, Thailand
  4. 4 Thoracic Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
  1. Correspondence to Dr Shinichi Sakura, Anesthesiology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan; ssakura{at}


Background Despite the popularity of continuous thoracic paravertebral block (TPVB), there is a paucity of information on catheter tip position and distribution of injectate through the catheter. We observed, in real time, the spread of dye, the catheter tip position and sensory block levels produced with three different (intercostal (IC), transverse process sagittal (TS) and paralaminar (PL)) approaches to ultrasound-guided TPVB in patients undergoing video-assisted thoracoscopic surgery.

Methods After the induction of general anesthesia, ultrasound-guided TPVB was conducted with a patient in the lateral decubitus position. During surgery, 10 mL of dye was injected through a catheter to observe the catheter tip and the dye distribution under thoracoscopy. Dermatomal sensory block levels were measured postoperatively.

Results Ten patients for each of three different approaches completed the study. There were a variety of dye spreading patterns. The median (range) number of segmental levels stained with dye was 1.5 (1–4), 3 (1–4) and 3 (1–5) with the IC, TS and PL approaches, respectively. We observed that a catheter tip was present at the same segmental paravertebral space as intended in 50%–90% of patients using these approaches. The median (range) number of dermatomes with sensory blockade at 6 hours after block was 2.5 (1–4), 3 (2–8) and 3 (1–8) with the IC, TS and PL approaches, respectively.

Conclusions Although a bolus injection through a catheter for ultrasound-guided TPVB produced multiple levels of spread and sensory blockade in more than half the patients, considerable differences existed in the spread regardless of approach.

  • anesthesia
  • local
  • regional anesthesia
  • pain management

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  • Contributors Study design: ST and SS. Patient recruitment: SS and YA. Acquisition of data: ST, SS, YA, AW and KK. Analysis and interpretation of data: ST, SS and YA. Writing up the first draft of the paper: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Shimane University Hospital ethical committee on April 10 2018 (study number 3110).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data are available on reasonable request to corresponding author (email: The information on the study can be seen on the web site: