ParaVertebral Catheters

Updated January 28, 2013
Author: Dixon, Gagnon

Description: Placement & Management of ParaVertebral Catheters

Patient Selection/ Indications: 
  • Thoracoscopic Lung Resections
  • Other thoracic cases requiring a chest tube, at the request of the surgeon. 
Considerations Prior to Placing Catheter: 
  • Follow guidelines for epidural analgesia regarding anticoagulation.
  • Place catheter pre-operatively when possible
Technique: 
  • Mark site as per Block Service guidelines.
  • Entry point @ T5-6 (or 1-2 segmental levels below incision) on the operative side.
  • Insert needle 2.5cm lateral to midline. Find transverse process with 18G Tuohy. 
  • After contact with transverse process pass needle cephalad of it to a depth of 1cm. 
  • After careful aspiration, bolus through the needle with 20ml of Ropivacaine 0.2% with Clonidine 100mcg added.
  • Thread catheter (use a styletted epidural catheter) 3cm into space if possible.
  • Avoid intrapleural placement (SOB, cough, "very easy" catheter threading).
  • Aspirate catheter for air/blood.
  • Secure catheter with mastisol, tegaderm and paper tape (like an epidural).
  • Tape adapter/catheter connection (as with an epidural).
  • Apply "Peripheral Nerve Catheter" label to catheter.
Intraop:

Infuse Ropivacaine 0.2% at 10ml/hr.

PACU
  • Document segmental anesthetic level. Typically there is a unilateral band of 2-6 dermatomes.
  • No BP changes should occur.
  • Order IV PCA for all patients unless there is specific reason not to do this.
  • Pt. should be signed out of PACU as you would with an epidural.
Infusion

Infuse Ropivacaine 0.2% at 10ml/hr.

Breakthrough Pain:
  • Bolus Paravertebral catheter with Ropivacaine 0.2% 10ml after negative aspiration. 
  • Consider increasing rate or changing to Ropivacaine 0.3%
Duration: 
  • Remove catheter when the chest tube is removed. 
  • If catheter is clearly nonfunctional, consult with the primary team before removing the catheter or replacing it with an epidural (rarely necessary).