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OP045 Anatomical and radiological evaluation of radiocontrast dye spread in the paravertebral space. Pig-tail catheter, epidural catheter and Tuohy needle administration comparison. A cadaver study
  1. Jaroslaw Merkisz1,
  2. Katarzyna Woloszyn-Kardas2,
  3. Jaroslaw Bartosinski1,
  4. Aleksandra Jozwiak-Bara1,
  5. Wojciech Dabrowski1,
  6. Edyta Kotlinska-Hasiec1,
  7. Grzegorz Staskiewicz3 and
  8. Grzegorz Teresinski3
  1. 1Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
  2. 2Department of Anesthesiology and Intensive Care, Medical University of Lublin, Jakubowice Koninskie, Poland
  3. 3Department of Forensic Medicine, Medical University of Lublin, Lublin, Poland


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Background and Aims The objective of the study was to evaluate the extent of spread of radiocontrast dye in the paravertebral space in human cadaver, depending on the injection method in response to variable analgesic effect noted in clinical conditions.

Methods 34 fresh frozen human cadavers were subjected to bilateral paravertebral space puncture using Tuohy needle at the level of 5th thoracic spine segment under ultrasound guidance. Metylene blue-iopromidum dye contrast was administered directly through Touhy needle, epidural catheter and pig-tail catheter. The spread pattern of injected contrast was then assessed by CT scan and further dissection.

Results The median (range) cephalo-caudad spread of contrast dye was 4 segments (3-8) regardless of the administration method. The median cephalad spread from the injection site was 1 thoracic segment, median caudad spread was 3 segments for Touhy needle, 2 segments for epidural and pig-tail catheter. The mediastinal (prevertebral) spread of dye was less frequent while performing injection through the pig-tail catheter in comparison to Tuohy needle and epidural catheter. The median ([IQR], range) spread to intervertebral foramina was 2([3], 0-5) for Tuohy needle, 3([2], 0-5) for epidural catheter and 0([1], 0-4) for pig-tail catheter and was statistically significant (p=0.001).

Abstract OP045 Figure 1

Different patterns of dye spread (Edipuralpig-tail catheter – left side, Tuohy needle – right side of the cadaver). Dissection

Abstract OP045 Figure 2

Paravertebral spread of radiocontrast dye after tuohyneedle administration. 3D CT scan reconstruction

Abstract OP045 Figure 3

An example of mediastinal, paravertebral and intercostal (wide) spread of radiocontrast dye given through epidural catheter. A CT scan

Conclusions Ultrasound-guided, saggital oblique approach to the paravertebral space is a reliable way to obtain multi-level spread of radiocontrast solution. Its range is highly variable and does not depend on the method of administration used. Contrast dye does not spread evenly in both directions from the injection site. All above may contribute to inadequate anesthesia in the clinical conditions.

  • paravertebral block
  • radiocontrast spread
  • cadaver study

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