Loss of Resistance Technique for Paravertebral Nerve Blockade Using the Episure™ Autodetect™ Syringe—A Case Report

Abstract

Postoperative pain is a frequent occurrence following breast surgery. Some authors have reported the incidence of postoperative pain following mastectomy and breast reconstruction to be as high as 50% when general anesthesia and intravenous narcotics are the primary anesthetic. An alternative anesthetic technique for breast surgery and postoperative analgesia is paravertebral nerve blockade (PVB). Greengrass and Weltz have described improved patient satisfaction, less analgesic requirement, and less total anesthetic use in those patients with preoperative PVBs. One of the challenges in providing successful analgesia from PVBs is the ability to correctly identify the paravertebral space. Landmark-based anatomy with penetration of the superior costotransverse ligament 1 cm past the transverse process has been previously described. Boezaart has described the use of loss of resistance (LOR) when performing PVBs. One potential difficulty with this technique is the reliance on the subjective feel of resistance loss as the needle passes into the paravertebral space. The Episure Autodetect Syringe is currently indicated by the US Food and Drug Administration for use with an epidural needle for the verification for needle tip placement in the epidural space. The principle, however, of LOR is similar when performing PVBs. We report a case of the successful use of the Episure Autodetect Syringe (ADS) for confirming entry into the paravertebral space. To our knowledge, this is the first described use of the ADS for performing PVB.