Needle advancement during thoracic paravertebral block using preprocedure ultrasound

Insert the needle at the markings determined with ultrasound. Once the needle contacts bone, grasp the needle as shown in the left panel, with the third finger tip firmly placed one centimeter from the skin. Keep that finger firmly in that same position while advancing the needle, to serve as a hard stop and prevent advancing the needle more than one centimeter beyond the depth of the TP. The depth marked by the third finger should not be deeper than the previously measured depth to pleura at that level. For further information refer to UpToDate content on performing thoracic paravertebral block with preprocedure ultrasound.