Ultrasound-Guided Paravertebral Block in an Infant
Jun Takeshita, MD, PhD
Osaka Women’s and Children’s Hospital

Thoracic paravertebral block (PVB) is a regional anesthetic technique wherein a local anesthetic is injected into the thoracic paravertebral space to produce a unilateral blockade of the spinal nerves and sympathetic chain. It provides effective analgesia after unilateral thoracic surgery and may reduce perioperative opioid requirements. Ultrasound guidance facilitates identification of the transverse process, superior costotransverse ligament, pleura, and needle trajectory, and allows accurate local anesthetic deposition.

This video demonstrates a left-sided, ultrasound-guided thoracic PVB at the fourth thoracic level in a 4-month-old, 7.6-kg male infant undergoing division of the vascular ring through a left fourth intercostal thoracotomy. The video underscores the identification of the relevant sonoanatomy, continuous visualization of the true needle tip, avoidance of the pleura and intercostal vessels, and careful advancement of the needle into the thoracic paravertebral space. A total of 3.8 mL of 0.25% ropivacaine was administered, corresponding to a dosage of 0.5 mL/kg and 1.23 mg/kg. The block was successfully performed without immediate block-related complications and provided effective perioperative analgesia for the thoracotomy. This video presents practical considerations for safe and reliable ultrasound-guided thoracic PVB in infants and young children.