Access to the extrapleural space at the time of surgery for continuous paravertebral block after flank incision: description of the technique and case series.

OBJECTIVE: To test our hypothesis that surgeon-placed paravertebral block (PVB) placement during open renal surgery is effective, feasible, and safe. Neuraxial analgesia represents the current standard of care for perioperative anesthesia for open renal surgery. However, potential catastrophic complications such as neuraxial bleeding and infection may occur. An alternative to neuraxial analgesia widely used in thoracic surgery is the surgeon-placed PVB. TECHNICAL CONSIDERATIONS: The surgeon-placed catheter is directed in the paravertebral space through the flank incision at the time of surgery. The postoperative catheter management was directed by anesthesiologists. All patients undergoing open renal surgery by a single urologist were provided a PVB for this series. Twenty-nine consecutive patients undergoing open renal surgery were given PVBs. Patients received an average of 5.1 mg of subcutaneous equivalent hydromorphone in the 48-hour postoperative period. No complications because of the PVB were found. CONCLUSION: PVB represents a safe and effective surgeon-placed alternative to neuraxial analgesia for open renal operative procedures.