Thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology: A literature review

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Abstract

BACKGROUND: Paravertebral anesthesia is an old regional anesthesia technique, with a history of more than 100 years. Generally, paravertebral anesthesia is used in adults as a strong analgesic tool for pain treatment. Paravertebral anesthesia is not a simple way of inducing regional anesthesia, as it has several complications. Paravertebral anesthesia has been a serious contraindication in pediatric surgery. At present, technical progress in ultrasonography permits the use of paravertebral anesthesia successfully in children in orthopedics and traumatology practice by discovering new possibilities for the surgical treatment of pain.

AIM: This study aimed to assess the current state and near-term prospects of using paravertebral anesthesia as a significant component of anesthesia in pediatric orthopedics and traumatology.

MATERIALS AND METHODS: Study data were obtained from public scientific sources, which were searched in the PubMed, Crossref, Google Scholar, Scopus, and RSCI databases without language restrictions. The depth of the information search was 90 years (up to 1932). In this study, analysis and synthesis based on the information obtained were used to build an analytic conclusion.

RESULTS: Various case reports and case reviews have described the experience of using thoracic and lumbar paravertebral anesthesia in pediatric orthopedics and traumatology, as well as reconstructive surgery and revealed that thoracic paravertebral anesthesia (in combination with general anesthesia) is currently the method of choice, competing with the thoracic epidural block and the high back straightening muscle block.

CONCLUSIONS: Paravertebral anesthesia as the psoas compartment block with the ultrasonography control is the most reliable and suitable method of regional anesthesia for pelvis orthopedic surgery.

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About the authors

Mikhail N. Dolgopolskii

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: mdolgopolsky@gmail.com
ORCID iD: 0000-0001-7690-2340

MD, Anesthesiologist and Intensivist

Russian Federation, Saint Petersburg

Viktor A. Koriachkin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Saint Petersburg State Pediatric Medical University

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Dmitrii V. Zabolotskii

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Saint Petersburg State Pediatric Medical University

Email: zdv4330303@gmail.com
ORCID iD: 0000-0002-6127-0798
SPIN-code: 6726-2571

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Rustam R. Safin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: safin_r.r@hotmail.com
ORCID iD: 0000-0003-0960-7426
SPIN-code: 7464-7151

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg; Saint Petersburg

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Supplementary files

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2. Fig. 1. Posterior and medial border of the paravertebral space by Macintosh (a) and Bruce-Smith (b) [10]

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3. Fig. 2. Contrast agents flow from left to right along the anterior surface of the thoracic vertebral bodies through the posterior mediastinum into the opposite PA (arrows) [12]

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4. Fig. 3. Fascia and muscles of the lumbar paravertebral space [17]

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5. Fig. 4. Ventral branches of the lumbar plexus and sacrolumbar trunk [17]

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