Chapter 126-130: Peripheral Nerve Blocks

Question 1

Compare and contrast epidural versus paravertebral block?

Answer 1

Paravertebral blocks provide better deafferentation than epidurals which allows for better preservation of pulmonary function; this also helps to attunate chronic pain and may decrease the incidence of metastasis when used for breast surgery

Question 2

Describe some clinical situations in which PVB should strongly be considered?

Answer 2

1) Breast surgery
2) Rib fractures + spinal or cranial trauma – allows for pain control while being able to continually assess neurlogic function
3) Because they can reverse ischemic pain, consider in patients that continue to have ischemic pain after medical/surgical optimization
4) obstetric anesthesia in patients have the anatomic abnormalities (harrington rods)

Question 3

Describe the anatomy of the paravertebral space

Answer 3

Wedge-shaped

1) anterolateral border- parietal pleura
2) posteriorly- superior costotranserve ligament (thoracic region only)
3) medial- vertebrae, vertebral disks, intervertebral foramina
4) superior and inferior- heads of ribs

Question 4

What the landmarks for performing paravertebral block?

Answer 4

spinal process is identified- mark is placed at superior edge of spinous process- and 2.5 lateral to this is where the needle should go, goal is to hit the transverse process and walk off NO MORE THAN 1 cm deep