CPT® Code 64462

Add-On Code

Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure)

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 paravertebral space is anatomically defined as a wedge-shaped compartment located adjacent to the vertebral bodies, which allows for communication superiorly and inferiorly across the ribs. Within this space, spinal nerves emerge from the intervertebral foramina and branch laterally into the paravertebral space, while intercostal nerves extend medially into the epidural spaces. The administration of a thoracic PVB effectively blocks both somatic and sympathetic nerves on the ipsilateral side, which is the same side as the procedure, while minimizing potential cardiovascular or respiratory complications. During the procedure, the patient is typically positioned in a supported sitting posture or in a lateral decubitus position with the side to be blocked elevated. The clinician marks the spinous processes on the patient's skin and measures a parasagittal line that is drawn laterally to the midline. Local anesthetic is then infiltrated into the subcutaneous tissue and paravertebral muscles along this line. Utilizing both visual and tactile landmarking techniques, along with ultrasound imaging when necessary, a spinal needle attached to a syringe containing local anesthetic is carefully inserted into the paravertebral space, where the anesthetic is subsequently injected. This procedure is crucial for pain management in various thoracic conditions and surgical interventions, providing significant relief and enhancing patient comfort during recovery.