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Title: Computerized tomographic anatomic relationships of the thoracic paravertebral space.
Austin Authors: Oon Tan, Chong;Botha, Christelle;Weinberg, Laurence ;Story, David A ;McNicol, Larry
Affiliation: Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 29-May-2013
Publication information: Journal of Cardiothoracic and Vascular Anesthesia 2013; 27(6): 1315-20
Abstract: A wide range of insertion points lateral to the midline are recommended for paravertebral blockade. The authors hypothesized that in a given subject, using an insertion point at the tip of the transverse process has a superficial but consistent depth to the pleura. The authors also hypothesized that for a given insertion point, depths to the pleura are related directly to the patient's anthropomorphic indices.Retrospective observational study.Adult tertiary teaching hospital.Forty-two adult patients.The authors reviewed the computerized tomography scans of 42 adult patients and correlated patients' body mass index, weight, height, and body surface area with skin and transverse process-to-pleura depths at the level of T4, 25 mm from the midline and from the tip of the transverse process. The authors found that the depth to the pleura from the transverse process was significantly deeper at 25 mm lateral to the midline than at the tip of the transverse process (21 mm [4.2mm] v 12 mm [2.7 mm], p<0.0001), and its variability was significantly larger (p = 0.005). The authors found significant correlation between anthropomorphic indices and depths to pleura and transverse process (r>0.8, p<0.0001); however, the prediction bands around their regression lines proved too broad to be clinically useful.The authors concluded that an insertion point at the tip of the transverse process may provide effective and safer paravertebral blockade and that depth to the pleura cannot be predicted reliably by patients' morphometric profiles.
Gov't Doc #: 23725686
DOI: 10.1053/j.jvca.2012.12.008
Journal: Journal of Cardiothoracic and Vascular Anesthesia
Type: Journal Article
Subjects: computerized tomography
paravertebral block
paravertebral space
transverse process
Aged, 80 and over
Anatomic Landmarks
Anesthesia, Spinal
Body Mass Index
Body Weight.physiology
Linear Models
Middle Aged
Nerve Block.methods
Pleura.anatomy & histology.radiography
Retrospective Studies
Skin.anatomy & histology
Thoracic Vertebrae.anatomy & histology.radiography
Tomography, X-Ray Computed
Appears in Collections:Journal articles

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