Paravertebral block: cervical, thoracic, lumbar, and sacral

Abstract

We discuss commonality and differences between the four types of paravertebral blocks, and newer indications and concerns, especially pertaining to nerve microanatomical differences, are highlighted.

Lumbar paravertebral blockade as intractable pain management method in palliative care

“…Boezaart et al use the following terms interchangeably: lumbar paravertebral block; lumbar plexus block; and psoas compartment block 59. As they state, irrespective of their specific names, all paravertebral blocks share certain characteristics; they are performed just outside the dura matter that extends from the spinal cord dura and surrounds the roots of the nerves or plexuses.…”

Ultrasound Guidance Is Helpful for Paravertebral Block Performance and Catheter Placement in Patients with Laminectomy after Thoracotomy or Lumbotomy: A Case Series Imaging Study

“…Among the interesting recently published data [6][7][8]11,12] are two methods to approach the PV area. While the classical approach [6,8,12] transposes the usual technique [4,5] relative to the USG approach, in the 3 to 4 cm lateral to the spine midline, the alternative corresponds to a retrograde intercostal approach that is more lateral (8 cm). Under the specific conditions described here (with a deep local redrafting after the preliminary laminectomy, Figures 2 and 3), the main concern was to determine with accuracy the persistence or not of the PV area in order to succeed in the catheterization technique for efficient postoperative pain control after the thoracotomy or the lumbotomy.…”

“…Although the postoperative pain of posterior fixation may be relatively easily controlled using standard general analgesia (opiates, nonsteroidal anti-inflammatory agents, paracetamol, or acetaminophen), pain control after a thoracotomy or a lumbotomy requires more systematically polymodal analgesia, including a regional anesthesia technique (paravertebral (PV) vs epidural block) to allow more comfortable and efficient respiratory physiotherapy for better recovery of pulmonary function and to decrease the incidence of possible lung complications [1][2][3]. The safe and efficient performance of these techniques is based on identification of local anatomical landmarks like the transverse processes [4,5]. Nevertheless, a laminectomy or the insertion of pedicle screws can interfere with these landmarks and may even contraindicate regional anesthesia.…”

A fatal accidental subarachnoid injection of lidocaine and levobupivacaine during a lumbar paravertebral block

“…Paravertebral block (PVB) -performed by Hugo Sellheim in 1905 -is the technique of injecting a local anaesthetic solution alongside the vertebral column, close to where the spinal nerves emerge, resulting in unilateral somatic and sympathetic nerve blockade [1].…”