Paravertebral anaesthesia/analgesia for ambulatory surgery

For many years, paravertebral nerve blockade has been an established technique for providing analgesia to the chest and abdomen. The current emphasis on containment of health care costs has resulted in a rediscovery of anaesthetic techniques, such as paravertebral blocks, that facilitate outpatient surgical management and promote early discharge. Paravertebral nerve blocks (PVB) produce excellent surgical conditions for many procedures of the chest and abdomen while providing profound long-lasting analgesia with few undesirable side-effects that aids in the compassionate early discharge of the patient from the ambulatory setting. This chapter reviews the pertinent anatomy and techniques involved in the successful placement of PVB. Continuous paravertebral catheters, pharmacological agents used in PVB, and single versus multiple injection paravertebral block techniques are also covered. Specific clinical situations that are particularly well suited to the application of PVB as the primary anaesthetic in the ambulatory setting and other clinical situations where analgesia from PVB is efficacious are discussed.