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Thoracic and lumbar somatic innervation extends from the chest and axilla to the toes.
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Paravertebral block has an advantage over neuraxial block in its ability to avoid widespread interruption of the sympathetic nervous system.
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Major somatic nerves are the ventral rami of the thoracic and lumbar nerves.
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The dorsal rami of the spinal nerves provide innervation to dorsal midline structures.
A number of regional anesthetic techniques rely on block of the thoracic or lumbar somatic (paravertebral) nerves. As illustrated in Fig. 29.1 , thoracic and lumbar somatic innervation extends from the chest and axilla to the toes. Although few major surgical procedures can be carried out under somatic block alone, appropriate use of somatic block with long-acting local anesthetics provides unique and useful analgesia. Also, when even longer-acting local anesthetics become available, possibly some form of thoracic or lumbar somatic nerve block, such as intercostal or paravertebral nerve block, will be able to provide even more useful postoperative analgesia. This is approaching clinical relevance with thoracic paravertebral use during care of patients undergoing breast surgery.
