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The distal paravertebral nerve block desensitizes the dorsal and ventral rami of the spinal nerves T13, L1, and L2 at the distal ends of the transverse processes of L1, L2, and L4, respectively. An 18‐gauge, 3.5‐ to 5.5‐cm needle is inserted ventral to the transverse process and 10 ml of local anesthetic is infused in a fan‐shaped pattern. The needle can then be removed completely and reinserted or redirected dorsal to the transverse process, in a caudal direction, where 10 ml of local anesthetic is again infused in a fan‐shaped pattern. This procedure is repeated for the transverse processes of the second and fourth lumbar vertebrae (Figure 17.3). Advantages of the distal paravertebral nerve block compared with the proximal paravertebral nerve block include lack of scoliosis, easier performance, and more consistent results. Disadvantages of the distal paravertebral nerve block compared with the proximal paravertebral nerve block include larger doses of anesthetic and variations in efficiency caused by differences in anatomic pathways of the nerves [2, 3, 5].

Figure 17.3 Distal paravertebral.

Source: From [2], © 1986, Elsevier.