Pain Clinical Trial
Official title:
A Prospective, Randomized Comparison Between the Ultrasound Guided Paravertebral Block and the Ultrasound Guided Proximal Intercostal Nerve Block
The purpose of this study is to compare the proximal intercostal block to the more medial (classic) ultrasound-guided paravertebral block. The investigators hypothesize that the proximal intercostal block will allow for improved needle visualization, shorter block time, and improved safety profile compared to the classic paravertebral bock.
Although previous studies have made advances towards applying ultrasound guidance to the
performance of paravertebral blocks (PVB), a technique combining both safety and technical
ease remains elusive. The ideal technique (1) permits continuous visualization of the entire
needle shaft and tip, (2) avoids aiming the needle tip and injectate directly toward the
neuraxis or lung, and (3) is easy to perform. Visualization of all structures by ultrasound
is essential to minimize the risk of vascular puncture, nerve root or spinal cord injury,
and pneumothorax. Failure to consistently and quickly identify the transverse process and
pleura, as occurs when using older techniques, results in several needle redirections,
causing pain and discomfort to patients, and increases the potential risk of pneumothorax.
The technical difficulty of applying previously-described US-guided techniques takes an
inordinate amount of time and is clinically less practical within a busy surgical practice.
In the current study, the investigators describe a novel, modified approach to real-time
ultrasound-guided single shot paravertebral blockade, the proximal intercostal block (PICB),
which utilizes a sagittal paramedian US probe placement to identify the intercostal space
and PVS. In this method, instead of placing the probe at a fixed traditional distance of 2.5
cm from the spinous processes, the probe is moved laterally to obtain a comprehensive image,
with a clear view of the ribs, internal intercostal membrane, and the parietal pleura.
The investigators propose that moving the probe laterally towards the proximal intercostal
space allows clearer simultaneous visualization of both pleura and needle as it advances
towards the PVS, while achieving comparable injectate spread and, ultimately, similar or
better clinical results. Such improved visualization will reduce the number of needle
passes, increase confidence in the user, decrease block placement time, and improve overall
block success. This technique combines the advantages of more lateral approaches (better
visualization of structures, in particular the pleura) with the advantage of the more medial
approaches (in-plane, closer, and not directed at the neuraxis).
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Basic Science
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