Paravertebral blockade – Underrated method of regional anesthesia

Paravertebral blockade (PVB) is an old, frequently forgotten and underrated method of regional anesthesia, with relatively few possible complications and an easy technique to perform. The aim is to describe anatomy of paravertebral space (PVS), present history of PVB, its mechanism of action, indications and contraindications, techniques, with particular emphasis on identifying the PVS with the use of ultrasound and advantages of its use in various clinical situations. This work was based on the available literature and the experience of the authors. Mechanism of action of PVB that includes somatic and sympathetic nerve blocks at a specific level, and requirements for its effectiveness and safety that rely on identification of anatomical landmarks, pressure differences, use of nerve stimulator, performed during thoracic surgery procedures, under visual control and ultrasound-guided, as a safe and accurate method with relatively the lowest number of complications, determines the use of this technique in the treatment of postoperative pain in certain clinical situations, as well as in breast surgery and hernia repair. Complications and adverse effects, including very rare, such as Harlequin syndrome, compared with complications of epidural anesthesia, confirm usefulness of this method of regional anesthesia. (1) PVB is a technically simple and relatively easy to learn technique of regional anesthesia, with low incidence of complications and contraindications. (2) It may be successfully used in breast surgery, hernia repair, as well as in surgical debridement and revision of small, superficial thoracic wounds, in case of herpes zoster, rib fractures, bruised liver and several other clinical situations. (3) Its principal use is management of postoperative pain in thoracic surgery, where it should be used more often as an alternative to epidural anesthesia which entails multiple complications and is considered the gold standard in certain abdominal or breast surgeries. (4) The best quality of PVB is provided with placement of the catheter under direct vision during thoracotomy.