Paravertebral block: cervical, thoracic, lumbar, and sacral

This article outlines the new developments around all four types of paravertebral block: cervical, thoracic, lumbar, and sacral.

It is emphasized that paravertebral blocks are all performed on the level of the roots of the nerves or plexuses, which are surrounded by dura mater extending from the dura mater surrounding the spinal cord. Because of this, they are all performed with essentially the same technique and they all have the same characteristics and problems associated with them, although they are called by many different names: 'cervical paravertebral' vs. 'posterior approach', 'psoas compartment' vs. 'lumbar plexus block' vs. 'lumbar paravertebral block', and so on. The knowledge that the roots are surrounded by dura and root level blocks are done just outside the dura should afford all paravertebral blocks the same respect as spinal epidural blocks because the potential of devastating complications such as intrathecal or intramedullary injection, for example, is shared. The advances in ultrasound and other novel approaches are described, yet the value of these has not been established.

We discuss commonality and differences between the four types of paravertebral blocks, and newer indications and concerns, especially pertaining to nerve microanatomical differences, are highlighted.