Paravertebral Block for Postoperative Pain Management After Open Thoracotomy: A Review of Efficacy and Risks.

PURPOSE OF REVIEW: Paravertebral block (PVB) is an increasingly utilized regional anesthesia technique for managing postoperative pain in patients undergoing open thoracotomy. Effective pain control following thoracic surgery is crucial for optimizing patient recovery, reducing opioid consumption, and minimizing respiratory complications.

RECENT FINDINGS: PVB provides unilateral analgesia by delivering local anesthetic to the paravertebral space, effectively blocking somatic and sympathetic nerve fibers. PVB has gained popularity as an alternative to epidural analgesia due to its efficacy and improved safety profile. While epidural analgesia remains the traditional gold standard for thoracic procedures, it is associated with complications such as hypotension, urinary retention, motor blockade, and the need for catheter placement. In contrast, PVB is easier to administer, produces less hemodynamic instability, and reduce systemic side effects. Recent literature suggests that PVB offers similar or improved pain control, reduced opiod requirements, and fewer postoperative complications. Risks such as vascular puncture, local anesthetic systemic toxicity, and incomplete spread persists; however, ultrasound guidance has iproved block reliability. Given its favorable safety profile and efficacy, PVB is emerging as a preferred option for postoperative pain control in open thoracotomy patients. Further research and randomized trials are needed to standardize technique, dosing, and peroperative protocols.