Thoracic paravertebral block

Abstract

Paravertebral nerve block produces ipsilateral analgesia through injection of local anaesthetic alongside the vertebral column. It is advocated predominantly for unilateral surgery, for example, thoracotomy, chest wall trauma, breast surgery, cholecystectomy, herniorrhaphy or renal surgery, although it can be used as a bilateral technique. In chronic pain, it is used for the treatment of benign or malignant neuralgia. There is confusion over the indications for this block and it is apparent that much ignorance surrounds this subject. Its place alongside extradural, intercostal and interpleural analgesia requires elucidation. The aim of this review is to describe the anatomy, techniques, analgesia, side effects and complications of paravertebral nerve blocks so that a more considered use of this form of analgesia can be undertaken.

A multifactorial approach to the factors influencing determination of paravertebral depth

“…3,8,18 Since we reported that the use of a blind technique led to a spray of dye anterior to the endothoracic fascia, at least as often as with the use of a neurostimulation approach, the difference between our results and those previously published may be attributed to differences in anthropometric characteristics of the patients included in these studies. on average, our patients had higher bMis compared to those subjects included in previously published studies.…”

“…8 This regional technique can also be used to provide unilateral somatic and sympathetic blocks, as required, for selected surgical procedures. 7,9,10 Additional postoperative benefits include a reduction in opioid requirements, earlier hospital discharge, 11 and a possible decreased risk for metastases and recurrence following surgery for breast cancer.…”

“…7,9,10 Additional postoperative benefits include a reduction in opioid requirements, earlier hospital discharge, 11 and a possible decreased risk for metastases and recurrence following surgery for breast cancer. 12 Several techniques have been described for entering the paravertebral space, including loss of resistance, nerve stimulator-guided, lateral/ intercostal approach, ultrasound assisted, 13 and even x-ray 8 and CT scan verified approaches. 14 Although the overall incidence of complications of paravertebral blocks is very low, 15,16 the risk of pneumothorax and unintended intrathecal injections remain an important clinical concern.…”

The ultrasound-guided retrolaminar block

“…1,[4][5][6][7] It is noteworthy that, with blind techniques, the loss of resistance felt with paravertebral needle placement is much less definite than that with epidural insertion. 8 The advent of ultrasoundguided regional anesthesia has offered the potential to improve efficacy and safety via real-time visualization of the paravertebral space, the surrounding structures, and the approaching needle. 1 As such, ultrasound has been applied to the traditional paravertebral approaches in an effort to reduce the risk of pleural puncture as well as to ensure better delivery of medications into the paravertebral space.…”

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

“…After collegial discussion, the theoretical positive ratio "analgesic advantage" against "infection risk" led the surgeon to accept the insertion of a catheter just below the surgical area. Consequently, because PV performance has been reported to be less risky in the anesthetized patient [11], we performed the PV block just after the surgery ended, when each patient had recovered efficient spontaneous breathing (e.g., respiratory rate >8 min…”