2.3.3. Ultrasound-Guided Nerve Blocks
PVS, nerve block
Patients in the PVB and RIB groups were intervened by ultrasound-guided nerve block in the lateral position with local anesthesia. The PVB was performed using the in-plane technique with a linear 4–10 MHz ultrasound probe (LOGIQe, GE Healthcare, Waukesha, WI., U.S.A.). At the parasagittal view, subcutaneous tissues, T5 transverse processes, superior costotransverse ligament (SCTL), and pleura were visualized. An 18 G block needle was inserted vertically or slightly caudally into the paravertebral space (PVS) under the guidance of ultrasound. After the penetration of the SCTL, a slight aspiration was performed to ensure the avoidance of vessels or pleura. Then, 1–2 ml of normal saline was injected into the PVS, the pressure of which pushed down the pleura. The position of the needle tip was confirmed, and 0.4% ropivacaine (Zhejiang Xianju Pharmaceutical Co., Ltd., Zhejiang, China) at 3 mg/kg was injected into the PVS.A linear 4–10 MHz ultrasound probe (LOGIQe, GE Healthcare, Waukesha, WI, U.S.A.) was placed on the medial border of the scapula between the 4th and 5th rib of the patients in the RIB group. In the ultrasound image, the trapezius muscle, rhomboid muscle, intercostal muscles, pleura, and lung were identified. Under the aseptic condition, an 18 G block needle was inserted laterally in the plane of the T5 level guided by an ultrasound probe with an in-plane technique. The vessel injection should be confirmed negative through aspiration, and 1–3 ml of normal saline was injected to divide the rhomboid and intercostal muscle, and 0.4% ropivacaine at 3 mg/kg was injected into the deep layer of the rhomboid muscle.