Trunk Block: Thoracic Paravertebral Nerve Block

Paravertebral block (PVB) has been used since the 1920s but has not been consistently performed until the last 25 years. With the advent of ultrasound-guided regional anesthesia, the use of PVB has become more widespread. Thoracic PVB (TPVB) is often used for surgical and post-operative analgesia for chest wall, thoracic and abdominal surgeries. TPVB can also be used for nonsurgical indications including rib fractures and chronic pain conditions. The space is a triangular shaped area which starts at T1 and terminates at T12 bound by vertebrae medially, pleura anterolaterally, and costo-transverse ligament posteriorly. As local anesthetic is injected into the space, the pleura will be displaced downward indicating appropriate needle tip location. Unique complications for a PVB include hypotension, epidural or intrathecal spread, pleural puncture and pneumothorax [1].