Paravertebral block and access to the paravertebral space – a reply
Bibliographic record
Abstract
We thank Pushpanathan and Pawa for their insightful comments 1 on our cadaver study of the paravertebral space 2 We agree that pleural depression is not always seen with injection posterior to the superior costotransverse ligament (SCTL), and that multi-level thoracic paravertebral block (TPVB) requires an injection anterior to the SCTL. We do however question the long-held dogma that the SCTL must be traversed with the needle tip, or that pleural displacement is necessary, to produce a single-level TPVB. We believe that the traditional teaching for multi-level injection (based on the landmark technique) will not reliably place the needle tip several millimeters from the pleura, and within the paravertebral space, hence the need (with a landmark technique) for multiple injections. The recently described retrolaminar PVB 3 and erector spinae plane block 4 involve injections well posterior to the SCTL, and yet would seem to result in paravertebral spread. We concur that injection deep to the SCTL is required for multilevel paravertebral dispersion, and are not suggesting a change of practice to injecting posterior to the SCTL. However, clinicians new to TPVB may be reassured that multiple injections at each level, posterior to the SCTL, could potentially result in successful block without the proximity to the pleura that is still seen by many as a downside to TPVB. More work is needed to further elucidate the mechanisms of local anesthetic spread in TPVB.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".