CPT® Code 64463

Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed)

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, where they interact with intercostal nerves that extend medially into the epidural spaces. The administration of a thoracic PVB effectively blocks both somatic and sympathetic nerves on the same side (ipsilateral) while maintaining minimal impact on cardiovascular and respiratory functions. During the procedure, the patient is typically positioned in a supported sitting posture or resting in a lateral decubitus position, with the side intended for the block positioned uppermost. The clinician marks the spinous processes on the patient's skin and measures a parasagittal line, which 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. For more complex cases, CPT® Code 64463 is utilized to report the continuous infusion of anesthetic through an indwelling catheter, which is threaded into the paravertebral space after the spinal needle is removed. This method allows for a sustained delivery of anesthetic, enhancing pain management during the postoperative period.