NYSORA - The New York School of Regional Anesthesia

Thoracic Paravertebral Block

Sat, 14 Mar 2009 18:24:00 +0000

The thoracic paravertebral block is a technique of injecting local anesthetic in the vicinity of the thoracic spinal nerves emerging from the intervertebral foramen with the resultant ipsilateral somatic and sympathetic nerve blockade.

Hasanul Arifin

Sat, 09 May 2009 11:01:48 +0000

this article is very good, and very useful for me and my students.

Michael Radstrom

Wed, 13 May 2009 15:11:24 +0000

The article is very useful in my daily work. The thoracic paravertebral block is excellent in breast surgery, but often insufficient when surgery reaches the axilla - T2 level. Any tips how to get better results in the axilla? Maybe the influence from cercvical level is to high? I usually inject 15 ml Ropivacain 7,5 mg/ml at T4 level.

Admin Response:

Thank you for the great question. Please post any questions you may have regarding Regional Anesthesia practices and techniques in THE FORUM found under MYNYSORA (the educational networking site for NYSORA.com)

Regards,
Vijay nysora.com admin

Dr. James Woodfine

Wed, 27 May 2009 06:14:43 +0000

I recently attended a workshop where the very experienced presenter demonstrated use of single paravertebral injection site at T3 (using ultrasound to measure depth of TP), using 20 mls 0.75% ropivacaine and a insertion of a catheter with postoperative infusion for breast surgery. The NYSORA site implies a need for multiple injection sites. Please advise on this discrepancy.

Michael Altose

Thu, 04 Jun 2009 13:29:23 +0000

I have the same question as Dr. Woodfine. If a paravertebral catheter at a single level is sufficient for full breast analgesia, why can't a single shot block around T4 (with a sufficient volume of local anesthetic) spread to cover the entire breast?

Nishant Kumar

Wed, 19 Aug 2009 15:37:20 +0000

We have been practising the thoracic paravertebral block both using multiple injection and the continuous catheter techniques. A simple 23-24G hypodermic needle 3" suffices for multiple injections whereas we use the touhy's needle with LOR with air (same as for epidural) for catheter placement. We however use it for the purpose of analgesia only. This website was indeed helpful in revisiting and refreshing the basic concept.