Who does paravertebrals?

[sevoflurane]

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Anybody incorporate paravertebral catheters/single shots into their paractice? Common or uncommon?

 

[pd4emergence]

Anybody incorporate paravertebral catheters/single shots into their paractice? Common or uncommon?

I did quite a few in residency. I did see and hear of enough complications(including one total spinal) with them that I haven't done any in private practice. If you are in the dural sheath (which extends a good ways peripherally) it is just not pretty. This girl stayed on the blower for a few hours and did fine but it is not an experience I wanted to repeat.

 

[BISof60]

I've done a handful of single shot paravertebrals in an outpatient setting. Great postop pain control.

 

[sevoflurane]

Yeah.... I'm on my 8th or so. When they work, they work great (about 80% of the time). Good option for the anticoagulated patient who needs post op pain control. At my institution we use them for mastectomies, thoracotomies, whipples... etc.

We actually do a modified technique that was published by our regional guy. We actually enter the neurovascular bundle underneath the rib at a relatively peripheral location usually 10 cm or so from the paravertebral gutters. Tunnel the catheter in the sheath and leave them in for a couple of days. We use mepivicaine-tetracaine-clonidine with epinephrine- about 20-25 mls per side. Then post up run .2 % ropivicaine with epi starting at 8 ml/hour.

They are pretty easy to place... but the major complication is a pneumo. So we make sure to hit the rib and walk off of it. Sounds like something that could be incorporated in private practice, but as mentioned above... I don't think it's too popular.