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Chapter: Clinical Anesthesiology: Regional Anesthesia & Pain Management: Chronic Pain Management

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Lumbar Paravertebral Nerve Blocks

Lumbar Paravertebral Nerve Blocks
Lumbar paravertebral nerve blocks may be useful in evaluating pain due to disorders involving the lum-bar spine or spinal nerves.

Lumbar Paravertebral Nerve Blocks

 

A. Indications

 

Lumbar paravertebral nerve blocks may be useful in evaluating pain due to disorders involving the lum-bar spine or spinal nerves.

 

B. Anatomy

 

The lumbar spinal nerves enter the psoas compart-ment as soon as they exit through the intervertebral foramina beneath the pedicles and transverse pro-cesses. This compartment is formed by the psoas fascia anteriorly, the quadratus lumborum fascia posteriorly, and the vertebral bodies medially.

 

C. Technique

 

The approach to lumbar spinal nerves is essentially the same as for thoracic paravertebral blockade (Figure 47–13). An 8-cm 22-gauge needle is usually used. Radiographic confirmation of the correct level is helpful. For diagnostic blocks, only 2 mL of local


anesthetic is injected at any one level, because larger volumes may block more than one level. Larger vol-umes of local anesthetic are used for therapeutic blocks, or to produce complete somatic and sympa-thetic block of the lumbar nerves.

 

D. Complications

 

Complications are primarily those of unintentional intrathecal or epidural anesthesia. Patients may experience paresthesias if inadvertent nerve injury occurs during needle placement. Some physicians advocate the use of a blunt-tipped needle to (theo-retically) decrease the chance of accidental intraneu-ral injection. Digital subtraction angiography with radiopaque contrast may lessen the risk of intravas-cular injection of local anesthetic or steroid.

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