Ultrasound guided paravertebral catheter placement and potential future improvements

A patient suffering with traumatic injuries including multiple rib fractures was excessively narcotized potentially impeding her recovery. A continuous infusion of local anaesthetic into the paravertebral space provided some opioid sparing effect, although the analgesic effect was less clear. The catheter was placed into the paravertebral space using a through-needle technique with ultrasound guidance. A discussion of the anatomical issues, including the endothoracic fascia is undertaken. Features of ultrasound imaging, needle guidance and catheter location are discussed Potential improvements to the technique of ultrasound-guided catheter placement are suggested, including speculative technological innovations that have yet to be fully evaluated but which may be of relevance. These include alternative ultrasound transducers, in-plane and out-of-plane needle approaches, modern highly echogenic needles, stimulating and coiling catheters, pressure transduction, 4D ultrasound and needle tracking sensors.