Contrast-enhanced paravertebrogram to confirm paravertebral catheter position in elective thoracic surgery: a proof of c
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and Other Interventional Techniques
Contrast‑enhanced paravertebrogram to confirm paravertebral catheter position in elective thoracic surgery: a proof of concept study Fredrik Klevebro1,2 · Madhan Kumar Kuppusamy1 · Shiwei Han1 · Sara Nikravan3 · Joseph M. Neal3 · Wyndam Strodtbeck3 · David L. Coy4 · Daniel Warren3 · Michal Hubka1 · Neil Hanson3 · Donald E. Low1 Received: 16 June 2020 / Accepted: 3 October 2020 © The Author(s) 2020
Abstract Background Paravertebral 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. 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). Results The 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. 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. Keywords Paravertebral pain catheters · Postoperative pain treatment · Thoracic surgery · Paravertebrogram Abbreviation ERAS Enhanced recovery programs after surgery Enhanced recovery programs after surgery (ERAS) typically include restrictive fluid protocols, regional anesthetic * Fredrik Klevebro [email protected] Donald E. Low [email protected] 1
Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA
2
CLINTEC, Karolinska Institutet, Stockholm, Sweden
3
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, USA
4
Department of Radiology, Virginia Mason Medical Center, Seattle, USA
techniques, and standards for early mobilization, all of which can potentially contribute to postoperative hypotension [1, 2]. A stable postoperative hemodynamic environment ensures appropriate splanchnic and cardiac perfusion, thereby decreasing the risk for postoperative complications including myocardial ischemia and anastomotic leak [3]. Although epidural pain catheters are used widely for
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