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Abstract
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Background and Aims The thoracic paravertebral block (TPVB) is a regional anaesthesic technique that can be performed as part of an opioid sparing, multi-modal analgesia technique for a wide range of surgeries. While TPVBs are relatively easy to perform with a high success rate, their use is not without risk. We describe a case of an ultrasound-guided TPVB where an artery, likely the dorsal branch of the posterior intercostal artery (PIA), was identified within the anticipated needle trajectory.
Methods A 61-year-old male presented for an elective right lower lobectomy. Post-induction, an ultrasound-guided right TPVB was planned. Prior to needle insertion, a pulsatile artery was identified in-between the two transverse processes of T7 and T8, at the level of their dorsal surfaces. The PIA usually lies deep to the superior costotransverse ligament (SCTL), within the paravertebral space. However the location of this artery was superficial to the SCTL, at the level of the dorsal surface of the transverse processes.
Results This was likely the dorsal branch of the PIA. There is significant variability and tortuosity of this artery, particularly at the level of the posterior paravertebral space. Real-time ultrasound visualization of the needle, as well as hydrodissection, was used to place the needle in the intended paravertebral space.
Conclusions Individual anatomical variations of the PIA and its dorsal branch may put them at an increased risk of inadvertent injury during TPVB. This emphasizes the benefit of an ultrasound-guided approach, and the importance for us to carefully identify vascular structures in the needle trajectory prior to the block.
Dorsal branch of the posterior intercostal artery