Paravertebral Block (PVB)

Ultrasound-Guided Paravertebral Block

The paravertebral block involves injecting local anesthetic into the paravertebral space, producing unilateral analgesia across multiple thoracic or lumbar dermatomes.

🧠 Anatomy

Paravertebral space:
- Lateral to the vertebral body and intervertebral foramen
- Boundaries:
  - Anterior: Parietal pleura
  - Posterior: Superior costotransverse ligament
  - Medial: Vertebral body
  - Lateral: Rib

Contents:
- Spinal nerve (dorsal and ventral roots)
- Sympathetic chain
- Fat and connective tissue

🔧 Technique

Patient position: Sitting or lateral decubitus
Ultrasound:
- Linear probe (thoracic), curvilinear for deeper/lumbar levels
- Parasagittal view, lateral to spinous processes
Landmarks:
- Transverse process (hyperechoic line with shadow)
- Pleura (mobile with respiration)
- Superior costotransverse ligament (target for needle entry)
Needle:
- In-plane, cranial-to-caudal approach
- Advance through the ligament into the space
Inject:
- 10–20 mL of local anesthetic
- Observe pleural displacement (anterior) or hydrodissection

💉 Indications

Thoracic surgery (e.g., VATS, mastectomy)
Rib fractures
Chronic thoracic pain (e.g., post-herpetic neuralgia)
Abdominal or lumbar surgery (for lumbar PVB)

✅ Advantages

Strong unilateral analgesia
Less risk of hypotension than epidural
No significant motor block
Suitable for high-risk surgical patients

⚠️ Complications

Pneumothorax
Vascular puncture
Epidural or intrathecal spread
Local anesthetic systemic toxicity (LAST)
Incomplete block if spread is limited

📊 Comparison</tab>

Feature	PVB	ESP Block	Intertransverse Block
Target	Paravertebral space	Erector spinae plane	Between transverse processes
Nerve coverage	Dorsal + ventral rami	Mainly dorsal ± ventral	Dorsal + ventral (variable)
Complexity	Intermediate	Easy	Moderate
Pleural puncture risk	Moderate	Low	Low
Spread to sympathetic chain	Yes	Rare	Possible