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Tables
Table 1 Baseline and perioperative characteristics of the patients.
Needle group (n = 17)
Catheter group (n = 17)
Age (years)
57.9 ± 12.1
52.5 ± 14.7
Sex (Male / Female)
8 (47%) / 9 (53%)
13 (76%) / 4 (24%)
BMI (kg/m2)
23.3 ± 3.8
23.7 ± 4.3
%VC (%)
87.3 ± 18.3
80.9 ± 19.1
FEV1.0% (%)
82.3 ± 5.9
85.8 ± 6.2
eGFR (mL/min/1.73 m2)
83.1 ± 22.7
87.5 ± 14.8
Operation time (min)
51.9 ± 7.9
49.7 ± 6.6
Anesthesia time (min)
102.6 ± 10.5
99.9 ± 11.1
In-out balance (mL)
508.5 ± 110.5
590.9 ± 133.8
Intra-operative remifentanil
0.13 ± 0.07
0.13 ± 0.04
average dose (µg/kg/min)
Values are mean ± standard deviation or number (proportion). %VC, vital
capacity as a percent of predicted; FEV1.0%, forced expiratory volume in 1
second as a percent of forced vital capacity; eGFR, estimated glomerular
filtration rate.
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Table 2 Comparison of the spreading patterns of ropivacaine to multiple
intercostal levels.
Catheter
Needle group
Spreading pattern
group
P-value
(n = 17)
(n = 17)
Multiple intercostal levels
17 (100%)
10 (59%)
[17, 0]
[4, 6]
[across the ribs, anterolateral aspect of
the VBs]
0.007**
Others
0 (0%)
7 (41%)
[single intercostal space, no change]
[0, 0]
[0, 7]
Odds ratio [95% confidence interval]
25.0 [1.29–483.99]✝
Values are number (proportion) of patients. VBs, vertebral bodies; **significant
difference (P < 0.01),
The odds ratio was calculated with Haldane-Anscombe 1/2 correction (i.e., the
addition of 0.5 to all cells).
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Table 3 Comparison of the use of an intraoperative vasopressor.
Needle group
Catheter group
Requirement of vasopressor
Yes
P-value
(n = 17)
(n = 17)
2 (12%)
10 (59%)
0.010*
No
Odds ratio [95% confidence interval]
15 (88%)
7 (41%)
0.09 [0.02–0.54]
Values are number (proportion) of patients. *significant difference (P < 0.05).
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Figure captions
Fig. 1 Ultrasound-guided thoracic paravertebral block techniques used in this
study.
(a) The patient is positioned in a lateral decubitus position with the surgical site
on the upper surface. (b) A ultrasonic probe (linear array transducer) is placed
just lateral to the spinous process and (c) the transverse plane ultrasound view
is obtained. A Tuohy needle is inserted in a lateral-to-medial direction from the
outer edge of ultrasonic probe and advanced until the needle tip reached the
lateral edge of the thoracic paravertebral space. The Tuohy needle is indicated
by the triangle mark. TP, transverse process; IIM, internal intercostal membrane;
PP, parietal pleura; VB, vertebral body.
Fig. 2 CONSORT flow diagram.
Fig. 3 Various spreading patterns of ropivacaine injected via a needle or a
catheter.
First, 10 ml saline is injected via the Touhy needle placed into the lateral edge of
paravertebral space (left image to middle image). Next, 20 ml of 0.5%
25
ropivacaine is injected via a needle as shown in (a), or a paravertebral catheter
as shown in (b), (c), and (d) (middle to right images).The ropivacaine is spread to
multiple intercostal levels: involved mainly across the ribs as shown in (a) and (b),
or an anterolateral aspect of the vertebral bodies as shown in (c). An
unobservable spreading pattern is shown in (d).
The gray arrows show the injection point of saline via a Tuohy needle and the
black arrows show the spreading of ropivacaine.
26
Video captions
Online Resource 1: Video 1
Injection via a Tuohy needle with spread across the ribs.
A local anesthetic is injected into a thoracic paravertebral space via a Tuohy
needle placed into the lateral edge of the paravertebral space. The local
anesthetic mainly spreads into the multiple intercostal levels, especially across
the ribs at the peripheral side of injection site.
Online Resource 2: Video 2
Injection via a catheter and spreading at the anterolateral aspect of vertebral
bodies.
A local anesthetic is injected into a thoracic paravertebral space via a
paravertebral catheter. The local anesthetic mainly spreads into the anterolateral
aspect of vertebral bodies around the sympathetic trunk at multiple intercostal
levels.
Online Resource 3: Video 3
Injection via a catheter and spreading across the ribs.
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A local anesthetic is injected into a thoracic paravertebral space via a
paravertebral catheter. The local anesthetic mainly spreads into the multiple
intercostal spaces across the ribs.
Online Resource 4: Video 4
Injection via a catheter and an unobservable spreading pattern.
A local anesthetic is injected into a thoracic paravertebral space via a
paravertebral catheter. The spreading of the local anesthetic is not identified
under thoracoscopy.
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