{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T19:56:32Z","timestamp":1779393392154,"version":"3.53.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n \n Thoracic paravertebral block (TPVB) is a clinically valuable regional anesthesia and analgesia technique for managing postoperative acute pain and certain chronic pain conditions. There are several approaches for ultrasound-guided TPVB. However, currently it is hard to provide an evidence-based recommendation on the choice between approaches. Comparisons of injectate distribution patterns among different approaches are limited. This observational cadaveric study compared dye distribution following TPVB using transverse\n in-plane<\/jats:italic>\n (TI) and sagittal\n in-plane<\/jats:italic>\n (SI) ultrasound-guidance.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Ten paravertebral injections at the T6-7 were performed on five cadavers. Left side received injections with TI approach, and right side with SI approach. All injections consisted of 20 mL of 0.02% methylene blue. The cadavers were dissected to evaluate dye distribution. The ChAracteristics of Cadaver Training and sUrgical Studies (CACTUS) guideline was adhered to conduct and report this study.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n All paravertebral injections resulted in dye staining in paravertebral space (PVS). On average, 3 [IQR (3, 3)] PVS segments were stained with TI approach, and 2 [IQR (1, 2)] with SI approach (\n p<\/jats:italic>\n = 0.26). Median intercostal staining area was 55.1 [IQR (30.1, 76.0)] cm\n 2<\/jats:sup>\n with TI and 38.3 [IQR (7.8, 82.6)] cm\n 2<\/jats:sup>\n with SI approach (\n p<\/jats:italic>\n = 0.50). Sympathetic chain staining was observed in 80% (TI) and 40% (SI) of cadavers (\n p<\/jats:italic>\n = 0.50). Regardless of injection approach, (1) the cephalad and caudal dye distribution was 1 [(IQR (0, 2)] and 0 [IQR (0, 1)] segment separately (\n p<\/jats:italic>\n = 0.04); (2) a significantly higher odds of PVS staining, and a significantly longer distance of intercostal space stained were observed at T6-7 (\n p<\/jats:italic>\n &lt; 0.001,\n p<\/jats:italic>\n &lt; 0.01) and T5-6 level (\n p<\/jats:italic>\n = 0.001,\n p<\/jats:italic>\n &lt; 0.01); (3) a positive association was observed between the number of PVS segments stained and sympathetic chain staining (\n p<\/jats:italic>\n = 0.003).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Both TI and SI ultrasound-guided TPVB approaches reliably target PVS. A predominantly cephalad distribution was noted with two approaches. No significant differences were observed between two approaches regarding the number of PVS segments stained, intercostal spread area, and the percentage of sympathetic chain stained. This study adds knowledge to the spread pattern of TPVB.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2025.1667862","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T06:33:18Z","timestamp":1762929198000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of injectate spread following transverse vs. sagittal in-plane ultrasound-guided thoracic paravertebral block: a cadaveric study"],"prefix":"10.3389","volume":"12","author":[{"given":"Jiali","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naili","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuelun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangyang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjiao","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaodan","family":"Bi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinhua","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuguang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2276","DOI":"10.21037\/jtd-21-1740","article-title":"Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review","volume":"14","author":"Hamilton","year":"2022","journal-title":"J Thorac Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1111\/anae.15609","article-title":"guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations","volume":"77","author":"Feray","year":"2022","journal-title":"Anaesthesia."},{"key":"B3","doi-asserted-by":"publisher","first-page":"3217","DOI":"10.2147\/JPR.S476563","article-title":"Nerve Blocks for Post-Surgical Pain Management: A Narrative Review of Current Research","volume":"17","author":"Niyonkuru","year":"2024","journal-title":"J Pain Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1111\/anae.14964","article-title":"guideline for oncological breast surgery: a systematic review and procedure-specific postoperative pain management recommendations","volume":"75","author":"Jacobs","year":"2020","journal-title":"Anaesthesia."},{"key":"B5","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/s44254-023-00043-1","article-title":"Perioperative multimodal analgesia: a review of efficacy and safety of the treatment options","volume":"2","author":"Kianian","year":"2024","journal-title":"Anesthesiol Perioperat Sci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"955778","DOI":"10.3389\/fonc.2022.955778","article-title":"Single ultrasound-guided thoracic paravertebral block with a large volume of anesthetic for microwave ablation of lung tumors","volume":"12","author":"Ni","year":"2022","journal-title":"Front Oncol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"295","DOI":"10.4097\/kja.22138","article-title":"Anatomical classification and clinical application of thoracic paraspinal blocks","volume":"75","author":"Kim","year":"2022","journal-title":"Korean J Anesthesiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1136\/rapm-2021-102588","article-title":"O J, Kwon HJ, Kim KW, Yang HM. 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