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Paravertebral block

If you are considering having a paravertebral block or have a procedure planned, it is important to know all you can about it. This includes:
 
  • why you need this procedure
  • what it will be like
  • how it will affect you
  • what risks are involved
  • any alternatives.
 
The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.
 
 

What is the problem?

You have a painful condition of the chest. This may be due to an injury to your ribs or breast, or the skin overlying these areas. The pain may be due to damage to the nerves themselves. This can be caused by an infection, such as shingles. Nerves can also be damaged during accidental injury or when a cut is made during an operation. The pain runs in a band around the chest, usually on only one side.
Paravertebral block

What is a paravertebral block?

A paravertebral block (PVB) is an injection, which is used to treat a number of different painful conditions. The injections are given into your upper back, to one side of the spine; this is called the paravertebral area. The needles are placed between the ribs, near the nerves that supply the chest wall and ribs. There is a small nerve lying just under the edge of each rib on both sides of the spine.
Paravertebral block 2
Local anaesthetic and anti-inflammatory steroid drugs can be injected around the nerves. By doing this painful conditions affecting the skin and chest wall can be relieved. Only a small amount of steroid is needed and it will not cause any of the side effects sometimes associated with taking steroid tablets. They are not the same kind of steroids that athletes may take.
 

What is the paravertebral area?

The paravertebral area is simply the area about a hands breadth wide, running up and down the back, on either side of the spine. This area runs parallel to the spine, which is made up of vertebrae; hence the name paravertebral.
Paravertebral block 3

What has gone wrong?

There are many different things that could have gone wrong to require a paravertebral block. Usually, either the chest wall or the nerve that carries painful messages from it has been damaged.
 
You should discuss the reasons for you needing the paravertebral block with your doctor.
 

The aims

The aim of the procedure is to reduce the pain messages coming from nerves around the chest. It is hoped this will produce long lasting relief from your pain. 
 

The benefits

Your pain should be reduced and you should be able to move around more easily. It should then be easier to perform your daily activities. The number of painkilling tablets you need to take should also be reduced.
 

Are there any alternatives?

By the time that you have the paravertebral block you should have already tried other more simple treatments. These include rest, both painkilling and anti-inflammatory tablets, and physiotherapy.
 
You may also have tried a transcutaneous electrical nerve stimulation (TENS) machine for your pain. This works by sending soothing pulses across the surface of your skin and along the nerve fibres. The pulses prevent pain signals from reaching the brain. They also stimulate your body to produce higher levels of its own natural painkillers, called endorphins.
 

What if you do nothing?  

If you do nothing there are several things that may happen:
 
  • With time and rest the pain may settle on its own
  • The pain and difficulty in moving around may remain the same
  • The pain may increase
 

Who should have it done?

The following groups of patients should have the procedure done:
 
  • Patients with chest wall pain
  • Patients with breast pain that has not settled by other means
 

Who should not have it done?

Each patient must make the final decision on whether to proceed or not. If you are unhappy about the procedure for any reason you should not continue.
 
There are specific medical situations when a paravertebral block should not be done and they are as follows:
 
  • When a patient is on medication that prevents blood from clotting, such as warfarin. This would lead to more bleeding than normal. It may be possible to stop the medication a few days before the procedure. This will need to be discussed with your doctor
  • When a patient is suffering from an illness that prevents blood from clotting, such as haemophilia. This would also lead to more bleeding than normal
  • When there is infection of the skin over the site where the needle needs to be put in. This could lead to infection in the deeper tissues
 
Also, some patients with severe breathing problems may not be suitable for this procedure.
 
Author: Dr Sean White FRCA. Consultant in pain and anaesthesia
© Dumas Ltd 2006
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