• Paravertebral blocks
    • Anatomy
      • Space begins at T1 and ends T12
      • PVB can be done at cervical level but there is no communication at these levels between spaces
      • Wedge shaped
      • Boundaries
        • Medial
          • Vertebrae, discs and foraminae
        • Lateral
          • Parietal pleura and innermost intercostal membrane
        • Posteriorly
          • TP of thoracic vertebrae, heads of ribs and superior costotransverse ligament
      • Contents
        • Spinal nerves
        • Grey & white rami communicantes
        • Sympathetic chain
        • Intercostal vessels
        • Fat
    • Technique
      Link:www.nysora.com/techniques/neuraxial-and-perineuraxial-techniques/landmark-based/3077-thoracic-paravertebral-block.html?print
      • Consent, IV access, monitoring, full resus equipment, trained assistant, asepsis
      • Sitting if awake with back/neck flexed. If asleep, operative side up
      • 1-4 dermatomes can be blocked by single injection otherwise multiple injection sites can be chosen. Lumbar level - spread is less so need to do multiple injections
      • Skin marked 25mm lateral to spinous process at desired level
      • Local infiltration followed by 18G epidural needle
      • Contact bone usually at 35mm if not try cranial/caudal movement only then try deeper.
      • Walk off the TP caudally and advance 1cm
      • Inject 20ml of 0.375% bupivicaine
    • Complications
      • Pneumothorax
      • Failure
      • Bilateral block
      • Horner's syndrome
      • Total spinal
    • CI
      • Local sepsis
      • Tumours in PVS
      • Allergy to LA
      • Patient refusal
      • Severe coagulapathy
      • Severe respiratory disease
      • Ipsilateral diaphragm paresis
      • Severe spinal deformities
    • Indications
      • Breast surgery
      • Thoracic surgery
      • Cholecystectomy
      • Renal surgery
      • Appendicectomy
      • Inguinal hernia repair
      • Fractured ribs
      • Liver capsule pain
      • Neuropathic chest pain
      • CRPS
      • Refractory angina
    • Advantages
      • Easy to learn
      • Safe in asleep patients
      • Low risk of neurological complications
      • Serum levels of LA lower than with inter pleural blocks
      • Hypotension is unusual
      • Reduction in chronic pain
      • Possible reduction in recurrence in breast cases
      • Possibly less hospital stay and less morbidity

    • Link:m.youtube.com/results?q=paravertebral%20block&sm=3
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/10/5/133.full.pdf