Paravertebral Blocks: Anatomical, Practical, and Future Concepts

This article aims to review the thoracic paravertebral block by discussing the relevant anatomy, and landmark and ultrasound-guided techniques. We will compare analgesic efficacy to established neuraxial techniques as well as discuss the complications. The quality of analgesia is comparable and non-inferior to epidural analgesia, especially for surgery involving a thoracotomy. The evidence regarding its use in abdominal surgery is not clear. There are long-term analgesic benefits for thoracic paravertebral blocks in breast surgery and it might potentially play a role in modulating cancer recurrence. Furthermore, latest research suggests an efficacious block can be achieved with a less invasive approach to the paravertebral space. The paravertebral block can achieve analgesia comparable to thoracic epidural, the use of ultrasound improves block success, and the complication rates are low. Novel techniques are emerging which might change the approach to the block in the future.