Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)
CPT4 code
Name of the Procedure:
Paravertebral Block (PVB) (Paraspinous Block), Thoracic; Single Injection Site (Includes Imaging Guidance, When Performed)
Summary
A Paravertebral Block (PVB), also known as a paraspinous block, is a procedure where a single injection of anesthetic is administered near the thoracic spine. The injection helps to numb specific nerves, providing pain relief for various medical conditions. Imaging guidance is often used to ensure accurate placement of the needle.
Purpose
The PVB is designed to provide pain relief and reduce the need for systemic pain medications. It is commonly used for pain management in surgical patients and could be performed for chronic pain conditions involving the chest, ribs, or upper back.
Indications
- Severe chest pain due to surgery or trauma
- Chronic pain conditions such as post-thoracotomy pain syndrome
- Pain management for rib fractures
- Pain relief for patients with localized cancer in the thoracic region
Preparation
- The patient may be instructed to fast for several hours prior to the procedure.
- Patients should disclose any medications they are currently taking, as certain medications may need to be adjusted.
- Pre-procedure assessments may include blood tests and imaging studies to identify the specific nerve targets.
Procedure Description
- The patient will be positioned to allow access to the thoracic spine.
- Local anesthesia is applied to numb the skin where the injection will occur.
- Using imaging guidance (such as ultrasound or fluoroscopy), a needle is carefully placed into the paravertebral space.
- An anesthetic agent is injected to block the targeted nerves.
- The needle is then removed, and the injection site is covered with a sterile bandage.
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
PVB is usually performed in a hospital, surgical center, or outpatient clinic.
Personnel
- Anesthesiologist or pain management specialist to perform the injection
- Nurse to assist with patient preparation and post-procedure care
- Radiology technician if imaging guidance is utilized
Risks and Complications
- Common risks: localized pain at the injection site, bleeding, and temporary numbness or weakness
- Rare risks: infection, nerve damage, punctured lung (pneumothorax), and spinal cord injury
Benefits
- Immediate pain relief in the targeted area
- Reduced need for systemic pain medications, which can minimize side effects
- Improved comfort and mobility, allowing for quicker recovery after surgery or injury
Recovery
- Patients may be monitored for a short period after the injection.
- Instructions may include avoiding strenuous activities for 24 hours.
- Follow-up appointments may be required to assess the effectiveness of the block and any need for additional pain management strategies.
Alternatives
- Systemic analgesics such as oral or intravenous pain medications
- Regional anesthesia techniques like epidural injections
- Non-pharmacological methods including physical therapy and acupuncture
Patient Experience
- Patients may feel an initial pinch and pressure during the injection.
- Pain relief is usually felt within the first hour and can last for several hours to days.
- Post-procedure discomfort is generally minimal and managed with over-the-counter pain medications.