CPT® Code 64461

A thoracic paravertebral block (PVB), also known as a paraspinous block, is a medical procedure designed to provide unilateral anesthesia, primarily for patients undergoing thoracic or breast surgeries, as well as those suffering from chest trauma or rib fractures. The procedure targets the paravertebral space, which is a wedge-shaped compartment located adjacent to the vertebral bodies. This space communicates superiorly and inferiorly across the ribs, allowing for effective anesthesia delivery. The spinal nerves emerge from the intervertebral foramina into the paravertebral space, where they branch laterally into the intercostal nerves and extend medially into the epidural spaces. By performing a thoracic PVB, healthcare providers can achieve ipsilateral somatic and sympathetic nerve blockage, which is beneficial in managing pain while minimizing cardiovascular or respiratory compromise. The procedure is typically performed with the patient positioned either sitting with support or in a lateral decubitus position, with the side to be blocked positioned uppermost. The procedure involves marking the spinous processes on the skin, measuring, and drawing a parasagittal line lateral to the midline. Local anesthetic is then infiltrated into the subcutaneous tissue and paravertebral muscles along this line. Utilizing visual and tactile landmarking, along with ultrasound imaging when indicated, a spinal needle is inserted into the paravertebral space, and local anesthetic is injected to achieve the desired anesthetic effect. Code 64461 specifically reports a single injection site for the thoracic PVB, including any imaging guidance that may be performed during the procedure.