Paravertebral Block (PVB)

A paravertebral block is a type of nerve block that numbs the breast or chest wall on the side that you are having surgery on. The paravertebral area is the area running up and down the back, parallel to the spine, which is made up of vertebrae; hence the name paravertebral. It is frequently combined with general anesthesia for larger surgeries of the breast, such as mastectomies. In some instances, it can be combined with sedation anesthesia for smaller surgeries of the breast, such as lump removals.

Whether or not a paravertebral block is right for you depends on your needs, medical history, and type of surgery. Your surgeon and anesthesia provider will discuss this with you, and you will decide together if a block is right for you.  It is unsafe to perform the injection on some patients. Be sure to discuss if you are using any blood thinners/anticoagulants or have a history of spine abnormalities or back surgery.

What are the benefits to a paravertebral block?

In addition to keeping you comfortable, pain control after breast surgery is fundamental to improve tolerance for deep breathing and coughing, which improves lung volumes and clears secretions, decreasing the risk for pneumonia. Improved pain control also allows improved movement, which decreases the risk of blood clots in your legs.

Studies have shown the following to be other benefits of PVBs:

  • Less narcotic use, and their side effects (respiratory depression, constipation, nausea, somnolence)
  • Less nausea and vomiting
  • Better patient satisfaction
  • Decreased chronic pain
  • Decreased cancer recurrence. Retrospective analyses have suggested a decreased rate of metastasis among patients undergoing breast cancer surgery who received a PVB. Trials are currently underway to obtain data needed to confirm this potential benefit.

What problems can occur following the block?

Unfortunately no procedure is free from risk, just as narcotics are not free from risk. Any serious risks are extraordinarily rare.

  • Bleeding
  • Any discomfort at the site of injection should be mild. Seek medical attention for severe pain, redness, discharge, swelling at the site of injection or fever.
  • Inadvertent uptake of medication into a blood vessel, which can cause system-wide problems, including very low blood pressure, abnormal heart rhythm, or seizure.
  • Inadvertent injection into the chest cavity, which can cause air to enter your chest (pneumothorax), and may require a small, temporary chest tube.
  • Injection of the anesthesia into your epidural or spinal space, which causes temporary numbness and weakness down to your toes.
  • Irritating or injuring your nerves
  • Not working as well or as long as intended

How is the block done?

This will be done before your surgery, while you are awake. Prior to the block placement, you will receive a sedative that will likely make you feel sleepy. After your block, you will be brought to the operating room, where your surgery will take place.

For the block you are positioned sitting up at the edge of the bed. An ultrasound is typically used to make sure that the needle is in the right place. You may feel some pressure in your back or chest during the injection. Typically, two to three injections are done to provide numbness to the entire breast area. If you are having a bilateral procedure, the process will be repeated on the other side of your back.