Your surgeon has requested that you receive a thoracic paravertebral nerve block for pain relief after your breast surgery. This pamphlet will describe the technique.
What is a nerve block?
Your anesthesia physician injects local anesthetic (e.g., Xylocaine) near the nerve (or nerves) supplying the part of your body where surgery will be performed. After the local anesthetic works on the nerve, that portion of your body will be numb for many hours, facilitating painless surgery and providing pain relief after the procedure.
As a common example: your dentist does a nerve block when he/she numbs your jaw before filling a cavity.
What is a Thoracic Paravertebral Nerve Block?
Your breast is supplied by approximately six nerves called intercostal nerves. Each intercostal nerve arises from a different segment of your backbone and travels under a rib to your breast. A thoracic paravertebral block (TPVB) means that your anesthesiologist blocks each nerve after it leaves the spinal canal, but before it hides under the rib.
During surgery, the surgeon may inject additional local anesthetic into the breast to make it more numb. Sometimes the surgeon and the anesthesia team may decide that it is best to have you go completely asleep in the OR. In that case you will have a breathing tube which is removed at the end of your operation. After surgery, you will be taken to the recovery room. Most patients who have received a TPVB have little pain, nausea, or vomiting after surgery, since the breast is numb from the paravertebral block. The pain relief from TPVB often lasts 18-24 hours and many patients require little or no pain medicine afterwards.
After 30-90 minutes in recovery, your family will come in to visit. You will then change into street clothes and get ready to go home; or, if you are an inpatient, you will be transported to your hospital room.
TPVB: Benefits
TPVB: Risks
Description of TPVB for breast surgery
You will meet with an anesthesiologist to review your health status and discuss the plan for your anesthesia care. If you decide to have a TPVB, this procedure will be done in the pre-op area before you go to the operating room for your surgery.
After you change into a hospital gown, an intravenous (IV) will be started. If you are uncomfortable during the procedure, the anesthesiologist can use the IV to give you sedative medications (e.g., Versed).
The anesthesiologist will feel along your backbone and mark the segments. The skin is anesthetized at each segment about 1 'l'2" off the midline (see picture). The physician then inserts a thin needle until it is close to the nerve and injects long-acting local anesthetic. For breast surgery, four to six nerves will be blocked. For surgery on both breasts, the blocks would be done on both sides.
After the nerve block, you will rest in the pre-op area for 30-40 minutes. This allows time for the local anesthetic to work. You will then go to the operating room. You will be given additional IV medications to relax you. A member of the anesthesia team is with you the entire time that you are in the OR to make sure that you comfortable and safe.
