Figure 3: Landmarks for TPVB

Mentions: Conventional technique:- Loss of resistance to air The block is performed with the patient in the sitting or lying down position with the neck flexed, back arched, and shoulders dropped forward. Mark a point 2.5 to 3cm lateral to the T4 spine (Figure 2,3). Following strict aseptic precautions the site of injection is infiltrated with 2% lignocaine. Needle is advanced directly posteroanterior, perpendicular to the skin, until contact with the pars intervertebralis, articular column, or transverse process of the particular vertebra was established. Loss-of-resistance syringe is attached to the needle and, while continuously testing for loss of resistance to air the needle is “walked off” the structure in an inferolateral (lateral and caudad) direction and advanced approximately 1 cm (but a maximum of 1.5 cm), ensuring that the bevel of the needle points laterally, away from the medial structures. As the costotransverse ligament is penetrated, a “pop” is felt, and there is a loss of resistance to air. This signifies paravertebral space.