Paravertebral Nerve Block

What is a Paravertebral Nerve Block?

A paravertebral nerve block is the unilateral block of the spinal nerve which will result in numbness of the common spot in the thoracic area.

What Should a Paravertebral Nerve Block be Used?

There are many specific procedures where this type of block is chosen over other types of anesthesia. One of the most common procedures is breast surgery when the patient doesn’t want or can’t use general anesthesia. It is also used for surgery in the midline abdominal area. It can be used for pain maintenance in patients with rib fractures or after a thoracotomy. A catheter can be used to offer constant pain relief as well.

Who Should not use a Paravertebral Nerve Block?

It is not recommended for a patient who has extremely thin blood to have a paravertebral nerve block. Also if there are signs of an infection near the area of the block, it is not recommended. If there is an untreated blood infection, it would not be recommended either. Of course, if the patient has any allergy to local anesthetic, they shouldn’t get this procedure either.

How Will the Block be Administered?

The patient is awake and must be in a sitting position. Most likely you will need help from a nurse to stay in a hunched-over position. The patient needs to bring her knees up to her chest and hug her legs. This will open up the areas where the needle needs to be inserted and make the block more successful. Fortunately, the procedure can be done fairly quickly with an experienced anesthesiologist.

How Successful is a Paravertebral Nerve Block?

As long as the block is put in the correct location, the block is extremely successful. The technique for placement is easier to learn than for other blocks. For pain maintenance, it can be a life-saving technique if the patient is in constant pain. Many times extreme pain can cause an elevated blood pressure which can be dangerous and hinder recovery. Pain maintenance using blocks like this will allow the patient to relax and stay lying still which is imperative in many types of injuries. Many times these blocks are used in conjunction with general anesthesia to limit the pain the patient is in when he comes out of general anesthesia.

What are the Possible Complications with a Paravertebral Nerve Block?

The following complication may occur with the use of a paravertebral nerve block:

1. Hypotension- unusually low blood pressure
2. Pleural puncture- can cause an accumulation of fluid or air in the pericardial sac which can be life-threatening
3. Vascular puncture
4. Pneumothorax- air escapes into the lung cavity which causes the lung to collapse
5. After the procedure, a full spinal block may occur which can cause respiratory failure
6. Toxicity of local anesthesia may result in mental status change, tachycardia, tinnitus, seizures
7. Nerve injury

It’s also possible that the block does not work because of improper placement of the anesthesia. Recently, ultrasound technology has been used to increase the reliability and safety of the placement of the needle for the block. The area where the needle needs to be inserted can be located more easily with the use of an ultrasound machine.

References

Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001 Sep. 95(3):771-80. Medline.

Hidalgo n, Ferrante fm. Complications of Paravertebral, Intercostal Nerve Blocks, and Interpleural Analgesia. finucane b. Complications of Regional Anesthesia. 2. NY, NY: Springer; 2007. 102-120.