64463 Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed)

Name of the Procedure:

Paravertebral Block (PVB) (Paraspinous Block), Thoracic; Continuous Infusion by Catheter

Summary

A Paravertebral Block (PVB) is a procedure where a local anesthetic is injected near the spinal nerves of the thoracic (chest) region through a catheter for continuous infusion. This technique is often paired with imaging guidance to ensure precise placement.

Purpose

The PVB is used to manage pain in the thoracic region, such as post-surgical pain or pain from rib fractures. The goal is to provide effective pain relief, improve patient comfort, and reduce the need for systemic pain medications.

Indications

• Postoperative pain following thoracic surgery (e.g., mastectomy, thoracotomy)
• Rib fractures or trauma to the chest
• Chronic pain conditions affecting the thoracic region

Preparation

• Patients may be required to fast for a certain period before the procedure.
• Adjustments to current medications, particularly blood thinners, may need to be made.
• Pre-procedure imaging or diagnostic tests, such as a chest X-ray or CT scan, might be necessary.

Procedure Description

1. The patient is positioned to allow access to the thoracic spine.
2. The area is cleaned and sterilized.
3. Local anesthesia is applied to the skin and deeper tissues.
4. With the aid of imaging guidance (e.g., ultrasound or fluoroscopy), the catheter is carefully inserted next to the spine.
5. The catheter is secured, and a continuous infusion of local anesthetic begins.
6. The placement and function of the catheter are confirmed via imaging.

Duration

The procedure typically takes about 30-60 minutes.

Setting

Usually performed in a hospital or a specialized outpatient surgical center.

Personnel

• Anesthesiologist or pain management specialist
• Medical imaging technician (if imaging guidance is used)
• Nursing staff

Risks and Complications

• Common: Hematoma at the injection site, temporary discomfort, or pain during needle insertion.
• Rare: Infection, nerve damage, pneumothorax (collapse of the lung), or local anesthetic systemic toxicity.

Benefits

• Effective and targeted pain relief.
• Reduced need for systemic opioids, lowering the risk of side effects.
• Enhanced patient comfort and potentially quicker postoperative recovery.

Recovery

• Close monitoring for a few hours after the procedure.
• Instructions on catheter care if it remains in place.
• Activities may be limited initially; follow-up appointments will be scheduled to assess pain control and remove the catheter when appropriate.

Alternatives

• Oral or intravenous pain medications.
• Epidural block.
• Intercostal nerve block.
• Each alternative has its own risks and benefits; for example, systemic medications can have widespread side effects, whereas other blocks may not provide as targeted pain relief.

Patient Experience

• The procedure is generally well-tolerated, with local anesthesia ensuring minimal discomfort during catheter insertion.
• Some initial soreness at the insertion site may be experienced.
• Continuous pain relief is typically noted within minutes to hours of starting the infusion, with careful monitoring for any adverse effects. Pain management strategies will be in place to ensure patient comfort throughout the process.