Pain Management Procedures
Erector Spinae Plane and Thoracic Paravertebral Blocks
Erector Spinae Plane and Thoracic Paravertebral Blocks
What are they?
Both procedures place local anesthetic in tissue planes beside the spine to reduce pain across a region of the back, chest, or abdomen. An erector spinae plane, or ESP, block deposits medication between a back muscle and a vertebral transverse process, allowing it to spread across several levels. A thoracic paravertebral block places medication deeper beside the vertebra where spinal nerves emerge, usually creating one-sided numbness over several rib levels.
When may they be recommended?
These blocks are widely used around thoracic, breast, abdominal, and rib surgery and may also be considered for selected acute or chronic chest-wall pain, rib pain, or postherpetic neuralgia. Evidence for chronic-pain uses varies, especially for the newer ESP block, so the diagnosis and goals should be clear.
What happens?
You sit, lie on your side, or lie face down. Ultrasound identifies the muscles, ribs or transverse processes, pleura, and nearby blood vessels. After skin numbing, a block needle is guided into the intended tissue plane, and local anesthetic is injected while its spread is observed. In some situations a temporary catheter is placed for continued medication.
What should I expect?
The treated side may feel warm, numb, or heavy. Relief may cover a broader area than a single intercostal block. Do not expose numb skin to heat or injury. The duration depends on the anesthetic and whether a catheter is used.
Important risks
Both blocks share risks of bleeding, infection, nerve injury, local-anesthetic toxicity, and incomplete or unintended spread. Paravertebral block has a specific risk of pneumothorax and accidental epidural or spinal spread; low blood pressure and temporary breathing effects can occur. Ultrasound improves visualization but does not eliminate risk.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.