Patient Position: Sitting up across the bed with a stool placed under the feet for stability.

Indications: Anesthesia and immediate postoperative analgesia for inguinal hernia, prostatectomy, and hysterectomy.

Needle size: 22-gauge, 79-mm Tuohy needle.

Volume: 5 mL 0.5% ropivacaine per segment.

Anatomic Landmarks: The paravertebral space is a wedge-shaped space on either side of the vertebral column. Boundaries: anteriorly—parietal pleura; medially—vertebral body, intervertebral discs, and intervertebral foramen; posteriorly—superior costotransverse ligament. The spinous process is the main bony landmark for this block.

Approach and Technique: The spinous processes are palpated and marked with the skin marker. The insertion points are marked 2.5 cm lateral to the superior border of the spinal process and infiltrated with local anesthetic. Then the Tuohy needle is placed perpendicular to the skin with bevel up and advanced up to 3 to 5 cm (Fig. 22-1). When the transverse process is found, the needle is pulled back to the skin and redirected caudally to walk off the inferior aspect or the transverse process, and is then advanced 1.0 cm past the premeasured skin-to-bone distance until a “pop” through the superior costotransverse ligament is appreciated. After the stylet is removed from the needle, the syringe with 0.5% ropivacaine is connected to the needle by extension tubing.

After negative aspiration, 5 ml of local anesthetic is injected at each level to be blocked.