You have accessJournal of UrologyOncology (TCC & Adrenal) & Teaching Techniques1 Apr 2010V767 SURGEON PLACED EXTRAPLEURAL CATHETER FOR CONTINUOUS PARAVERTEBRAL BLOCK FOLLOWING FLANK INCISIONS: A CASE SERIES DEMONSTRATING ACCESS TO THE EXTRAPLEURAL SPACE AT THE TIME OF SURGERY Gordon Launcelott, Gavin Langille, and Ricardo A. Rendon Gordon LauncelottGordon Launcelott More articles by this author , Gavin LangilleGavin Langille More articles by this author , and Ricardo A. RendonRicardo A. Rendon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1361AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neuraxial (epidural) analgesia (NA) has been the gold standard for pain control following thoraco-abdominal and flank surgeries. Continuous thoracic paravertebral block is an alternative to continuous NA for lateral thoracotomy. Continuous paravertebral local anaesthetic block (CPVLAB) has been shown to minimize common side effects associated with NA, while avoiding potential catastrophic complications as a result of neuraxial bleeding or infection. Although CPVLAB has been used for renal surgery it has been performed by Anaesthesiologists via percutaneous access, requiring a great deal of operator skills and experience to ensure correct catheter placement with variable success rates. We present a novel alternative technique of accessing the paravertebral space via an extrapleural approach at the time of flank surgery. METHODS Fourteen consecutive patients receiving flank incisions for open radical or partial nephrectomy were given CPVLAB via the extrapleural approach. The extrapleural plane is bluntly developed to the necks of the 8th through 12th ribs in the extrapleural space. A catheter is placed with a Tuohy needle passed percutaneously over the 11th rib. Following catheter placement, a bolus of 0.5% bupivacaine is given. For the remainder of the postoperative period, a continuous infusion of ropivacaine is supplemented with breakthrough opioids. RESULTS The 14 patients had successful catheter placement and function. They received an average of just 0.6 mg breakthrough IV hydromorphone in the postoperative recovery room. In the 48 hour postoperative period, patients received the equivalent of just 10.6 mg breakthrough oral hydromorphone. There were no complications that arose from the use of this technique. CONCLUSIONS Surgeon-placed CPVLAB is a novel, safe and very effective method of providing analgesia in the postoperative period for thoraco-abdominal and flank surgeries. This represents a significant advance in the postoperative pain management of such patients. We hypothesize that this method is as effective as epidural analgesia, but associated with less opioid-induced side effects and avoids the potential catastrophic complications associated with neuraxial manipulation. At our institution surgeon-placed CPVLAB is the method of choice for lateral thoracotomy and thoracoabdominal surgery for open partial and radical nephrectomy. Halifax, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e300-e301 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gordon Launcelott More articles by this author Gavin Langille More articles by this author Ricardo A. Rendon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...