BACKGROUND Thoracic paravertebral blockade is an accepted anesthetic and analgesic technique for breast surgery. However, real-time ultrasound visualization of landmarks in the paravertebral space remains challenging. We aimed to compare ultrasound-image quality, performance times, and clinical outcomes between the traditional parasagittal ultrasound-guided paravertebral block and a modified approach, the ultrasound-guided proximal intercostal block. METHODS Women with breast cancer undergoing mastectomy (n = 20) were randomized to receive either paravertebral (n = 26) or proximal intercostal blocks (n = 32) under ultrasound-guidance with 2.5 mg/kg ropivacaine prior to surgery. Block ultrasound images before and after needle placement, and anesthetic injection videoclips were saved, and these images and vidoes independently rated by separate novice and expert reviewers for quality of visualization of bony elements, pleura, relevant ligament/membrane, needle, and injectate spread. Block performance times, postoperative pain scores, and opioid consumption were also recorded. RESULTS Composite visualization scores were superior for proximal intercostal compared to paravertebral nerve block, as rated by both expert (p = 0.008) and novice (p = 0.01) reviewers. Notably, both expert and novice rated pleural visualization superior for proximal intercostal nerve block, and expert additionally rated bony landmark and injectate spread visualization as superior for proximal intercostal block. Block performance times, needle depth, opioid consumption and postoperative pain scores were similar between groups. CONCLUSIONS Proximal intercostal block yielded superior visualization of key anatomical landmarks, possibly offering technical advantages over traditional paravertebral nerve block. TRIAL REGISTRATION ClinicalTrials.gov, NCT02911168. Registred on the 22nd of September 2016.

中文翻译：

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近端肋间阻滞与椎旁阻滞超声可视化的前瞻性、随机比较。

背景胸椎旁阻滞是一种公认​​的乳腺手术麻醉和镇痛技术。然而，椎旁空间标志物的实时超声可视化仍然具有挑战性。我们的目的是比较传统旁矢状超声引导椎旁阻滞和改良方法（超声引导近端肋间阻滞）之间的超声图像质量、执行时间和临床结果。方法 接受乳房切除术的乳腺癌女性 (n = 20) 被随机分配接受椎旁阻滞 (n = 26) 或近端肋间阻滞 (n = 32)，术前在超声引导下使用 2.5 mg/kg 罗哌卡因。保存针放置前后的块超声图像以及麻醉注射视频剪辑，这些图像和视频由单独的新手和专家评审员独立评估骨元素、胸膜、相关韧带/膜、针和注射液扩散的可视化质量。还记录了阻滞执行时间、术后疼痛评分和阿片类药物的消耗量。结果 根据专家 (p = 0.008) 和新手 (p = 0.01) 评审员的评分，近端肋间神经阻滞的综合可视化评分优于椎旁神经阻滞。值得注意的是，专家和新手都认为胸膜可视化优于近端肋间神经阻滞，专家还认为骨标志和注射液扩散可视化优于近端肋间神经阻滞。各组之间的阻滞执行时间、针深度、阿片类药物消耗量和术后疼痛评分相似。结论 近端肋间阻滞对关键解剖标志具有出色的可视化效果，可能比传统椎旁神经阻滞具有技术优势。试验注册 ClinicalTrials.gov，NCT02911168。注册日期：2016年9月22日。