Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Seven. Intravenous Regional Blocks for the Upper & Lower Extremity > Chapter 43. Thoracic & Lumbar Paravertebral Block Manoj K. Karmakar, MD, Anthony M-H. Ho, MD

Thoracic Paravertebral Block

"Thoracic paravertebral block (TPVB) is the technique of injecting local anesthetic alongside the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramen.^1,2 This produces unilateral, segmental, somatic, and sympathetic nerve blockade,³ which is effective for anesthesia and in treating acute and chronic pain of unilateral origin from the chest and abdomen.¹ Hugo Sellheim of Leipzig (1871–1936) is believed to have pioneered TPVB in 1905.^1,2 Kappis, in 1919, developed the technique of paravertebral injection, which is comparable to the one in present-day use. Although paravertebral block was fairly popular in the early 1900s, it seemed to have fallen into disfavor during the mid and later part of the century, the reason for which is not known. In 1979 Eason and Wyatt rekindled interest by describing a technique of paravertebral catheter placement.⁴ Our understanding of the safety and efficacy of TPVB has improved significantly in the last 25 years, and there has been a gradual renewal of interest in this technique. Currently it is used not only for analgesia but also for surgical anesthesia,^5–7 and its application has been extended to children.^8–10The thoracic paravertebral space (TPVS) is a wedge-shaped space located on either side of the vertebral column (Figure 43–1). The parietal pleura forms the anterolateral boundary. The base is formed by the vertebral body, intervertebral disc, and the intervertebral foramen..."