• Fredrik Klevebro, Madhan Kumar Kuppusamy, Shiwei Han, Sara Nikravan, Joseph M Neal, Wyndam Strodtbeck, David L Coy, Daniel Warren, Michal Hubka, Neil Hanson, and Donald E Low.
• Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA, 98101, USA. fredrik.klevebro@ki.se.
• Surg Endosc. 2021 Nov 1; 35 (11): 6001-6005.

BackgroundParavertebral pain catheters have been shown to be equally effective as epidural pain catheters for postoperative analgesia after thoracic surgery with the possible additional benefit of less hemodynamic effect. However, a methodology for verifying correct paravertebral catheter placement has not been tested or objectively confirmed in previous studies. The aim of the current study was to describe a technique to confirm the correct position of a paravertebral pain catheter using a contrast-enhanced paravertebrogram.MethodsA retrospective cohort proof of concept study was performed including 10 consecutive patients undergoing elective thoracic surgery with radiographic contrast-enhanced confirmation of intraoperative paravertebral catheter placement (paravertebrogram).ResultsThe results of the paravertebrograms, which were done in the operating room at the end of the procedure, verified correct paravertebral catheter placement in 10 of 10 patients. The radiographs documented dissemination of local anesthetic within the paravertebral space.ConclusionThis proof of concept study demonstrated that a contrast-enhanced paravertebrogram could be used in conjunction with standard postoperative chest radiography to add valuable information for the assessment of paravertebral catheter placement. This technique has the potential to increase the accuracy and efficiency of postoperative analgesia, and to set a quality standard for future studies of paravertebral pain catheters.© 2020. The Author(s).

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