Thoracic paravertebral block for percutaneous transhepatic biliary drainage

Percutaneous transhepatic biliary drainage is a painful procedure most commonly performed after intravenous sedation. Despite systemic opiates and benzodiazepines, most patients experience significant pain during the procedure and in the recovery period. Paravertebral blocks allow the spinal nerve roots and sympathetic chain in the paravertebral space to be anesthetized, and their role in providing analgesia for thoracic and upper abdominal surgical procedures is well-established. Herein a case is described in which thoracic paravertebral blockade dramatically reduced standard intra- and postprocedural analgesic needs and provided superior pain control.