Block It Like Itās Hot: Regional Anesthesia, Pain Medicine & POCUS S3:E2 "Paravertebral: The King of Nerve Blocks š¤“ (Part 2)"
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Feb 15, 2025 Dive into the world of paravertebral blocks as hosts dissect needle trajectories and probe positioning. Discover the quirks of Pawa's Pleural Groan and the debate over single versus multi-level strategies. They explore the risks of pneumothorax, especially in anticoagulated patients. With practical tips on ultrasound visualization and hydrolocation techniques, they'll have you laughing while learning about sympathetic blockade and the exciting renaissance of paravertebral techniques. Jokes sprinkled throughout keep the conversation lively!
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Prefer Transverse In-Plane For Teaching
- Try a transverse in-plane scan as a default for teaching paravertebral blocks because it offers a larger surface and easier pleural visualization.
- Let trainees kneel in-plane to reduce negotiation between narrow spaces and improve confidence during needling.
Move Insertion Point To Reduce Steep Angles
- If you adopt transverse in-plane, place the needle insertion point a bit further from the probe's lateral edge to reduce steep needle angle and improve ultrasound visibility.
- A shallower entry improves visualization and reduces acute approach angles at depth.
Slide Off Transverse Process To Improve View
- Slide the probe cranial or caudal off the transverse process if ribs obstruct your view and needle trajectory, but recognize lamina to avoid central neuraxial puncture.
- Use lamina-and-pleura view as an alternative to reduce bony impedance when necessary.