What is the technique for inserting the needle during a proximal paravertebral block?

• A. Insert at a 45-degree angle
• B. Insert 1 inch off the midline
• C. Insert directly into the vertebrae
• D. Insert only at the caudal edge of L3

Answer: (B)

The proper technique for inserting the needle during a proximal paravertebral block involves positioning the needle 1 inch off the midline. This approach is critical as it targets the specific nerves that are located in close proximity to the transverse processes of the vertebrae without risking damage to the vertebral structures themselves.

Inserting the needle off the midline allows the clinician to effectively access the T13, L1, and L2 nerve roots, which are responsible for innervating the skin and musculature of the flank and abdominal wall. Achieving the correct angle and distance from the midline ensures that local anesthetic is delivered appropriately into the paravertebral space, maximizing efficacy while minimizing complications.

While other techniques may suggest specific angles or insertion points, the focus on a 1-inch lateral positioning relative to the midline is essential for successful anesthesia in the designated surgical area.