A Review of the Paravertebral Block: Benefits and Complications

Paravertebral nerve blocks (PVB) have experienced a surge over the past 2 decades as improved access to ultrasound has increased ease of performance. The purpose of this review is to identify recent findings with regard to PVB's uses, including benefits, risks, and recommendations.

PVB is reported as an effective method of analgesia both in intraoperative and postoperative applications, with novel applications showing its potential to replace general anesthesia for certain procedures. The use of PVB as a method of analgesia postoperatively has shown lower opioid usage and faster PACU discharge, when compared to alternative approaches like the intercostal nerve block, erector spinae plane block, pectoralis II block, and patient-controlled analgesia. Thoracic epidural analgesia and a serratus anterior plane block are comparable to PVB and can be used as alternatives. The incidence of adverse events is consistently reported to be very low with few new risks being identified as the use of PVB expands. While there are worthwhile alternatives to PVB, it is an excellent option to consider, particularly for higher-risk patients. For patients undergoing thoracic or breast surgery, PVB can improve opioid usage and shorten the length of stay leading to an overall positive impact on patient recovery and satisfaction. More research is needed to further expand novel applications.