3.15 Paravertebral Block

Question 1

Outline borders + contents of paravertebral space

Answer 1

Potential space
Each side

Lateral to bony vertebral column
Thoracolumbar region

Boundary

1.Anterolateral:

Parietal pleura
in thorax

Sacrospinalis + psoas
Abdomen

2. Posterior

TV Process + costo TV ligament thorax

3. Superior head of adjacent rib thoracic region

Question 2

Contents Paravertebral Space

Answer 2

1. Spinal Roots
   emerge intervertebral formina
   Enter space
   give white rami comm join syma cain

Nerve root divide
Dorsal and Ventral branch
before leave space

2. Sympathetic chain
3. Fat
4. Lymph Node
5. Vessels

Question 3

Paravertebral N block

Set up

Answer 3

SLIMRAG

Single shot / Multiple levels

Patient Sit / Lateral
- can insert catheter

Spinous process @ level blocked
Mark 2.5 Laterally

~~ TV process of vertebral body
Lumbar Region

Vertebral body below for thoracic region
Owing to sloping nature thoracic process

Question 4

Paravertebral N block

Procedure

Answer 4

Appropriate needle
Blunt / atraumatic / tuohy

Inserted perpendicular to all planes
3-5cm

Bony contact
TV process

Needle walked off TV process caudally
advanced 1 more cm

May feel subtle pop in thoracic region as cross costo-tb

Negative aspiration = 3-5ml LA per level
or catheter

Question 5

Indications

Answer 5

Breast
Thoracic
Open Chloe
Nephrectomy
Hernia repair
VATS

Trauma - #rib

Sy control hyperhidrosis

Chronic pain -
post herpetic neuralgia
CRPS
Malignancy

Question 6

Complications

Answer 6

1. Inadvertent IV injection
2. LAST
3. PTX
4. Extradural or Intrathecal spread
   intervertebral foramina
5. Ipsilateral Horner’s
6. Haematoma
7. Infection
8. Nerve injury
9. Bilateral injection
   may get hypotension from sympathetic block