Contrast-enhanced paravertebrogram to confirm paravertebral catheter position in elective thoracic surgery: a proof of concept study

Fredrik Klevebro,Wyndam Strodtbeck,Joseph M Neal,Sara Nikravan,David L Coy,Michal Hubka,Donald E Low,Madhan Kumar Kuppusamy,Shiwei Han,Daniel Warren,Neil Hanson

doi:10.1007/s00464-020-08087-1

Abstract

BackgroundParavertebral pain catheters have been shown to be equally effective as epidural pain catheters for postoperative analgesia after thoracic surgery with the possible additional benefit of less hemodynamic effect. However, a methodology for verifying correct paravertebral catheter placement has not been tested or objectively confirmed in previous studies. The aim of the current study was to describe a technique to confirm the correct position of a paravertebral pain catheter using a contrast-enhanced paravertebrogram.MethodsA retrospective cohort proof of concept study was performed including 10 consecutive patients undergoing elective thoracic surgery with radiographic contrast-enhanced confirmation of intraoperative paravertebral catheter placement (paravertebrogram).ResultsThe results of the paravertebrograms, which were done in the operating room at the end of the procedure, verified correct paravertebral catheter placement in 10 of 10 patients. The radiographs documented dissemination of local anesthetic within the paravertebral space.ConclusionThis proof of concept study demonstrated that a contrast-enhanced paravertebrogram could be used in conjunction with standard postoperative chest radiography to add valuable information for the assessment of paravertebral catheter placement. This technique has the potential to increase the accuracy and efficiency of postoperative analgesia, and to set a quality standard for future studies of paravertebral pain catheters.

Highlights

Paravertebral pain catheters have been shown to be effective as epidural pain catheters for postoperative analgesia after thoracic surgery with the possible additional benefit of less hemodynamic effect
The medial border represents the vertebra and is visible as a straight line; the lateral border shows indentations of the ribs and nerve bundles. This proof of concept study is the first to demonstrate the feasibility and efficacy of confirming paravertebral pain catheter position with the use of an intraoperative paravertebrogram. This technique provides an opportunity for objective confirmation of paravertebral pain catheters, which gives valuable information relevant to immediate postoperative pain management and, if applied in clinical research, can increase the quality of paravertebral pain catheter studies by confirming proper catheter placement, thereby facilitating opportunity to adjust or replace the catheter prior to leaving the operating room
Paravertebrogram can be performed in conjunction with mandatory postoperative radiography, which makes the exam time efficient and adds only the cost of contrast dye and a few minutes of time in the operating room

Summary

Introduction

Paravertebral pain catheters have been shown to be effective as epidural pain catheters for postoperative analgesia after thoracic surgery with the possible additional benefit of less hemodynamic effect. Methods A retrospective cohort proof of concept study was performed including 10 consecutive patients undergoing elective thoracic surgery with radiographic contrast-enhanced confirmation of intraoperative paravertebral catheter placement (paravertebrogram). Conclusion This proof of concept study demonstrated that a contrast-enhanced paravertebrogram could be used in conjunction with standard postoperative chest radiography to add valuable information for the assessment of paravertebral catheter placement. This technique has the potential to increase the accuracy and efficiency of postoperative analgesia, and to set a quality standard for future studies of paravertebral pain catheters

Objectives

Methods

Results

Conclusion