What is the role of thoracic spinal nerve blocks in pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Thoracic paravertebral somatic or selective blocks (SNRBs) can alleviate pain involving the thoracic paraspinal regions, chest, and abdomen. SNRBs are helpful in determining the cause of nociception when patients complain of thoracic segmental neuralgia caused by nerve root impingement or inflammation due to vertebral column or foraminal pathology. Thoracic paravertebral blocks can also be used to quell the pain due to acute and chronic herpes zoster and other neuropathic pain syndromes, postthoracotomy, skeletal muscle spasm, and fractures or other structural complications associated with osteoporosis, surgery, and traumatic injuries to the chest wall or upper abdomen.

The thoracic paravertebral nerves exit their respective intervertebral foramina just beneath the transverse process of the vertebra. After exiting the intervertebral foramen, the thoracic paravertebral nerve provides a recurrent branch that loops back through the foramen to provide innervation to the spinal ligaments, meninges, and its respective vertebra. The thoracic paravertebral nerve interfaces with the thoracic sympathetic chain and then divides into an anterior and posterior primary division. The posterior innervates the facets, paraspinal muscles, and the skin of the back. The anterior division moves laterally into the subcostal groove and then under its respective rib to become an intercostal nerve.

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