Regional Anesthesia - Thoracic Paravertebral Block for Regional Anesthesia of the Thorax and Abdomen
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Anatomy. The thoracic paravertebral space is a wedge-shaped space containing the intercostal nerves, dorsal rami, sympathetic chain, as well as adipose tissue and the intercostal vessels (Fig. 18.21). The boundaries of this space are formed anteriorly by the parietal pleura and posteriorly by the superior costotransverse ligament, which adjoins the lower border of the transverse process from above to the upper border of the rib below. The base of this wedge is formed by the lateral border of the vertebral body, intervertebral foramen, and intervertebral disk. The apex of this wedge continues laterally in conjunction with the intercostal space. The left and right paravertebral spaces at a specific level are in continuity with each other medially via the intervertebral foramen and epidural space and anteriorly via the prevertebral space.