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Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
There are two types of joint between the ribs and the vertebrae in the thoracic region: the costovertebral and costotransverse joints. The costovertebral joint is between the head of the rib and the vertebral body. The radiate ligament crosses this joint. The ligament is so-named because it fans out from the head of the rib to its insertions on the vertebral body. The costotransverse joint is between the tubercle of the rib and the transverse process of the vertebra. There are lateral and superior costotransverse ligaments at this joint. The lateral costotransverse ligament passes from the rib tubercle to the transverse process it articulates with. The superior costotransverse ligament passes from the superior border of the rib to the transverse process of the vertebra above.
Analgesic efficacy of pre-emptive ultrasound-guided mid-point transverse process to pleura block for patients undergoing posterolateral thoracotomy incisions: Randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2023
Heba Abdelhamid Mohammed, Aliaa Muhammad Belal, Rehab Said Elkalla, Sohair Mostafa Soliman
Costach et al. marked the introduction of the mid-point transverse process to pleura (MTP) block as a modified paravertebral block in 2017 [8]. Injections of LAs are made between the transverse process and the pleura. The LA travels via the fenestrations in the superior costotransverse ligament at the injection level and frequently to adjacent levels, reaching the dorsal and ventral rami in the paravertebral region [9].
A prospective randomized comparison of the efficacy of standard antiviral therapy versus ultrasound-guided thoracic paravertebral block for acute herpes zoster
Published in Annals of Medicine, 2022
Yingchao Ma, Bingsi Li, Lei Sun, Xin He, Shuang Wu, Fan Shi, Li Niu
All procedures were performed in outpatient operating room under the ultrasound (US) guidance by the same skilled pain physicians who demonstrate expertise in performing US-guided TPVB. Electrocardiography, blood pressure and oxygen saturation monitoring were applied. Patients were in the lateral position with the affected side facing upward. A low-frequency convex array probe (Philips iU22 DS; Philips Medical Systems, Cleveland, OH) was applied transversely to the targeted lateral aspect of the thoracic spinous process. In the short axis view of the thoracic paravertebral area, paravertebral muscles and the hyper-echoic transverse process were identified clearly. The black acoustic shadow in front of the transverse process completely obscured the thoracic paravertebral area. The hyper-echoic area among parietal pleura, superior costotransverse ligament (SCL) and internal intercostal membrane which represents the top of thoracic paravertebral space (TPVS) or the medial boundary of posterior intercostal space was correspondingly identified by slightly moving the transducer cranially or caudally. Subsequently, colour Doppler mode was used to identify whether a vulnerable blood vessel was abnormally situated around the targeted TPVB area in order to avoid intravascular injection. A 22-gague needle with echogenic (Benlan, Oakville, Canada) was introduced under real-time US-guided from lateral to medial section with an in-plane technique to target the hyper-echoic TPVS top or the posterior intercostal space. After confirmation of the needle tip, 2 ml of 1% lidocaine was injected for test. Each patient was monitored for five minutes for the clinical signs of anaesthesia/HZ associated pain alleviation in the affected thoracic dermatomal. After verification, 5 ml of block liquid mixture was slowly injected to the TPVS for each involved nerve root under the real-time US guidance. Meanwhile, the hyper-echoic pleura were moved forward and the top of TPVS was expanded due to the spread of the injectable suspension in the real-time ultrasonic image (Figure 2(a)). Each affected nerve root by HZ was identified to be accessed and blocked using the above TSA method under US guidance.
The Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Paravertebral Block and Mid-Point Transverse Process Pleura Block in Mastectomy Surgeries: A Randomized Study
Published in Journal of Investigative Surgery, 2022
Agâh Abdullah Kahramanlar, Mehmet Aksoy, Ilker Ince, Aysenur Dostbıl, Erdem Karadenız
All blocks were fulfilled by the same anesthesiologist, who had at least five years of experience in the profession, with the help of a linear probe (1–8 MHz) and using 22 G, 100 mm insulated facet tip needles before general anesthesia. Patients were placed in a sitting position, spinous processes were marked starting from the C7 spinous process to the T6 level. Then, patients were placed in the prone position. After cleaning the area with an antiseptic solution, the sterilized linear USG probe (Esaote MyLab30®, CA631 high-frequency probe, United Kingdom) was covered. The linear probe was placed between two transverse processes on the paramedian plane; superior costotransverse ligament, transverse processes, and pleura were consecutively visualized. The linear ultrasound probe was fixed to the T3-T4 vertebra level. After the skin was anesthetized with 2% lidocaine, a 22 gauge 100 mm needle (Stimuplex ®; B. Braun, Melsungen, Germany) was led in a cranial-cephalic direction to the paravertebral gap. Trapezius, rhomboid, and erector spinae muscles were crossed by seeing the tip of the needle. Transverse processes were reached and the intercostal muscles were passed. When the needle reached the paravertebral space after passing through the superior costotransverse ligament in Group 1, and between the mid-point of the posterior border of the transverse process and the pleura in Group 2, the needle location was confirmed with 0.5–1 mL of saline, and 20 mL of 0.25% bupivacaine was injected. Local anesthetic dissemination was observed in both cranial and caudal directions. Thirty minutes after block application, the sensorial block level was evaluated by pinprick test using18-gauge needle (normal sensation: 0, decreased sensation: 1, insensitivity: 2) at the midclavicular line. Sensory block was determined by the patient’s verbal response to the stimulus followed by pinprick and the blocked dermatome area was recorded as front and back. The duration from placing the patient in the prone position to removing the block needle following the end of the local anesthetic injection is defined as the block performance time and recorded. Complications developed during the process (such as hypotension, pneumothorax, vascular injury, and local anesthetic toxicity) were recorded.