What is Thoracic Block?
The thoracic paravertebral block involves injecting local anesthetic in the area of the thoracic spinal nerves emerging from the intervertebral foramen with the resultant ipsilateral somatic and sympathetic nerve blockade.
Effects of Thoracic Block
The thoracic block results in ipsilateral somatic and sympathetic nerve blockade in multiple contiguous thoracic dermatomes above and below the site of injection.
Prior to the actual procedure, the doctor will evaluate the patient and explain the procedure in detail, including possible complications and side effects. The doctor will also answer any questions that the patient may have. The patient should inform the doctor of his drug allergies, medications he is taking, medical conditions and any previous reactions to anesthesia.
The Thoracic Block Procedure
The patient is positioned in the sitting or lateral position and then the skin surrounding the injection site will be cleansed with an antiseptic solution. The injection should be carried out slowly to minimize pain. Any new needle reinsertions should be made through already anesthetized skin.
The needle is then inserted perpendicular to the skin, while constantly paying attention to the depth of needle insertion and the medial-lateral needle orientation. It is essential that utmost care should be paid to avoid medial needle direction. After the transverse process is contacted, the needle is withdrawn to the skin and redirected superior or inferior to walk off the transverse process. The main goal is to insert the needle to a depth of 1 cm. past the trans-verse process. A certain “give” occasional can be felt as the needle passes through the costotransverse ligament, however, this is non-specific and should not be relied on.
After the procedure, the patient may continue to take his regular pain medicine, with the exception of limiting pain medicine within the first 4 to 6 hours after injection so that the diagnostic information obtained is accurate. The patient may be referred for physical therapy or manual therapy after the injection while the numbing medicine is effective and/or over the next several weeks while the cortisone is working.
The patient may resume regular activities on the next day. It is also advisable to start regular exercise and activities in moderation once the pain has improved. Even if the pain relief is significant, it is still important to gradually increase activities over 1 to 2 weeks to avoid recurrence of pain.
Some complications to this procedure include infection, hematoma, local anesthetic toxicity, nerve injury, total spinal anesthesia, quadriceps muscle weakness and paravertebral muscle pain.
What is the purpose of a thoracic block?
The goal of thoracic block is not just to block noxious afferent stimuli from the surgical site, but also to impart a bilateral selective thoracic sympathectomy. Provision of pain relief and sympatholysis of such magnitude that allows patients to cough, breath deeply, drink and mobilize can contribute to enhanced post-operative results.
What are the benefits of this procedure?
A single injection produces multi-dermatomal ipsilateral somatic and sympathetic nerve block. It also maintains hemodynamic stability and reduces opioid requirements. There is also a low incidence of complications. Thoracic block preserves bladder sensation, lower limb motor power and also promotes early mobilization.
What should I do on the day of the procedure?
On the day of the injection, the patient is advised to avoid performing any strenuous activities, unless instructed by their physician. The patient should not drive unless approved by the treating physician. If sedation was used, the patient should not drive for at least 24 hours after the procedure.
Will it hurt?
The patient may notice a slight increase in pain lasting for several days as the numbing medicine wears off and before the cortisone starts to take effect. If the area is uncomfortable in the first 2 to 3 days after the injection, carefully apply ice or a cold pack to the injection site to provide pain relief.