Name of the Procedure:

Paravertebral block (PVB), also known as paraspinous block, thoracic; second and any additional injection site(s) (includes imaging guidance, when performed)

Summary

A paravertebral block (PVB) is a minimally invasive procedure used to deliver local anesthetic near the spinal nerves to provide pain relief, particularly in the thoracic (upper back) region. The block is particularly helpful in managing post-surgical pain or localized pain due to injuries.

Purpose

The paravertebral block is primarily used to reduce pain in the upper back and chest area. It aims to provide effective analgesia by blocking the pain signals from multiple spinal nerves. The procedure is often used for postoperative pain management after surgeries involving the chest, ribs, or upper abdomen.

Indications

• Postoperative pain following thoracic surgery (e.g., lobectomy, mastectomy)
• Rib fractures
• Chronic pain syndromes involving the thoracic region
• Trauma to the thoracic spine or chest

Preparation

• Fasting for at least 6 hours before the procedure
• Adjustment or temporary discontinuation of certain medications, such as blood thinners
• Pre-procedure evaluation including medical history, physical examination, and sometimes imaging studies like X-rays or MRI

Procedure Description

1. The patient is positioned to allow access to the thoracic spine.
2. An antiseptic solution is applied to the skin over the injection site.
3. Local anesthesia is administered to numb the skin and surrounding tissues.
4. Under imaging guidance (ultrasound or fluoroscopy), a needle is carefully inserted near the targeted spinal nerves.
5. Local anesthetic, with or without additional medication, is injected into the paravertebral space.
6. For multiple sites, the needle is repositioned, and additional injections are administered as needed.

Duration

The procedure typically takes about 30 to 60 minutes, depending on the number of injection sites.

Setting

The procedure is usually performed in an outpatient clinic, hospital, or surgical center.

Personnel

• Anesthesiologist or pain management specialist
• Nurses or medical assistants
• Imaging technician (if imaging guidance is used)

Risks and Complications

• Common: Pain at the injection site, temporary numbness or weakness
• Rare: Infection, bleeding, nerve damage, pneumothorax (collapsed lung), allergic reaction to the anesthetic Complications are usually managed with appropriate medical care.

Benefits

• Significant pain reduction in the targeted area
• Decreased need for systemic pain medications
• Enhanced ability to participate in physical therapy and recovery Benefits are often realized immediately or within a few hours after the procedure.

Recovery

• Patients may be monitored briefly after the procedure to ensure there are no immediate complications.
• Instructions will include avoiding strenuous activities for 24 hours.
• Follow-up appointments may be scheduled to assess the effectiveness and need for additional treatments.
• Normal activities can usually be resumed within a day or two, based on individual recovery.

Alternatives

• Systemic pain medications (oral or injectable)
• Epidural anesthesia
• Other regional nerve blocks
• Physical therapy and rehabilitation Each alternative comes with its own set of benefits and drawbacks, such as differences in effectiveness and potential side effects.

Patient Experience

Patients may feel a brief sting or pressure during the local anesthetic administration. Afterward, they might experience a warm or tingling sensation as the anesthetic takes effect. Pain relief is usually rapid, and discomfort is minimal. Post-procedure instructions and pain management strategies aid in ensuring comfort during recovery.