Ultrasound-guided thoracic paravertebral block

Thoracic paravertebral block produces ipsilateral somatic and sympathetic nerve blockade in multiple contiguous thoracic dermatomes above and below the site of injection, which is effective in treating acute and chronic pain of unilateral origin from the chest or abdomen. It is frequently performed using surface anatomical landmarks and loss of resistance. Recent advances in ultrasound (US) technology and image-processing capabilities of US machines have made it possible to image the thoracic paravertebral space, which may offer several advantages when used for paravertebral injections. US is noninvasive, safe, simple to use, no radiation is involved, and one can preview the paravertebral anatomy before block placement. This allows one to accurately determine the distance to the transverse process and pleura. Preliminary data suggest that it is feasible to perform US-guided thoracic paravertebral block and also observe the spread of the injected local anesthetic in real-time. This may translate into improved technical outcomes, higher success rates, and reduced needle-related complications. However, currently, there are limited data on US-guided thoracic paravertebral block, and future research to establish its role in clinical practice is warranted.

Keywords: Anesthesia, Analgesia, Paravertebral, Nerve block, Ultrasound, Technique