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ANALGESIA

Ultrasound-Guided Paravertebral Block Using an Intercostal Approach

Alon Ben-Ari, MD^*, Milena Moreno, MD^*, Jacques E. Chelly, MD, PhD, MBA^*, and Paul E. Bigeleisen, MD^*

From the *Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and Department of Anesthesiology, University of Rochester, Rochester, New York.

Address correspondence and reprint requests to Paul E. Bigeleisen, MD, Department of Anesthesiology, Box 604, Strong Memorial Hospital, 601 Elmwood Ave., Rochester, NY 14642. Address e-mail to bigeleisenpe{at}upmc.edu.

Abstract

We describe an ultrasound-guided technique of continuous bilateral paravertebral block using an intercostal approach in 12 patients undergoing elective abdominal surgery. Postoperatively, each of the patient’s paravertebral catheters was bolused with 10 mL lidocaine (15 mg/mL), and each of the patient’s catheters was infused with 0.2% ropivacaine at 10 mL/h. Using a pinprick test, the median number of dermatomes blocked after the initial bolus was 5 (interquartile range, 4–6), and 23 of 24 catheters produced a local anesthetic block. The median verbal pain score on postoperative day 1 was 5.5 (interquartile range, 3.5–6), and median dose of IV hydromorphone consumed during the first 24 h after surgery was 1.9 mg (interquartile range, 0.7–5.05). All catheters were removed within 72 h after surgery.