Paravertebral anesthesia

Local anesthetics are used for topical anesthesia, local infiltration, peripheral nerve block, paravertebral anesthesia, intravenous block also known as regional anesthesia, epidural block, and spinal i.e. subarachnoid blockade. The local anesthetics may be divided into two main groups, the esters and the amide-type agents. 

Brachial plexus anesthesia Buccal anesthesia Caudal anesthesia Cervical plexus anesthesia Dental anesthesia Digital anesthesia Epidural anesthesia Intercostal nerve anesthesia Interpleural anesthesia Intra-articular anesthesia Intradermal anesthesia Intrathecal (spinal) anesthesia Intravenous regional anesthesia Laryngeal anesthesia Lumbar plexus anesthesia Nasal anesthesia Neck anesthesia Obstetric anesthesia Ocular anesthesia Oropharyngeal anesthesia Otic anesthesia Paravertebral anesthesia Perianal anesthesia Peritonsillar anesthesia Respiratory anesthesia Sciatic nerve anesthesia Stellate ganglion anesthesia... 

Postural headache after thoracic paravertebral nerve anesthesia, and probably reflecting dural entry, has been reported (343). Nerve root damage is another possible complication. Hematuria due to injury to the kidney or ureter is an unusual complication of lumbar paravertebral sympathetic block (344). 

Epidural anesthesia is administered by injecting local anesthetic into the epidural space—the space bounded by the ligamentumflavum posteriorly, the spinal periosteum laterally, and the dura anteriorly. Epidural anesthesia can be performed in the sacral hiatus (caudal anesthesia) or in the lumbar, thoracic, or cervical regions of the spine. Its current popularity arises from the development of catheters that can be placed into the epidural space, allowing either continuous infusions or repeated bolus administration of local anesthetics. The primary site of action of epidurally administered local anesthetics is on the spinal nerve roots. However, epidurally administered local anesthetics also may act on the spinal cord and on the paravertebral nerves. 

The accidental injection of local anesthetics into the subarachnoid space can occur during paravertebral sympathetic blocks or stellate gangUon block. A total spinal anesthesia can result Treatment of this complication consists of immediate artificial ventilation and support of the circulation by intravascular fluids and vasopressors. To prevent such complications, precise CT control is mandatory with contrast medium test injection to confirm the exact position of the needle tip before any drug instillation. 

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