The paravertebral fascial plane block: A novel, ultrasound-guided technique for paraspinal neck and back pain

Introduction

Paraspinal myofascial pain syndrome (MPS) is a common cause of emergency department (ED) visits, but existing therapies often provide incomplete or short-lived relief. Increasing evidence implicates the fascia as a key driver of the pain in MPS, supporting targeted interfascial interventions.

Methods

We conducted a single-center retrospective observational cohort study of adult ED patients who received a novel, ultrasound-guided paravertebral fascial plane block (PFPB) between September 1, 2024 – August 31, 2025. Eligible patients presented with focal cervical, thoracic, or lumbar paraspinal pain consistent with MPS and had either inadequate response to ED analgesics or a history of refractory paraspinal MPS. The PFPB procedure consisted of two components: (1) injection of a combination of anesthetic, normal saline, and dexamethasone within the fascial planes between the paraspinal muscles, and (2) needling of the muscular fasciae. Numeric Rating Scale (NRS) pain scores were documented for clinical care purposes at pre-block baseline, ED discharge, and 24–48-h follow-up.

Results

Eleven patients (median age 48 years, 64 % female) underwent the PFPB. Median NRS pain score decreased significantly from 9/10 (interquartile range [IQR] 8–9) pre-block to 3/10 (IQR 0–4) at discharge (n = 11, p = 0.004). At 24–48 h (n = 10), the median pain score was 1/10 (IQR 0–2.75), with 80 % reporting sustained or improved relief relative to discharge. No complications occurred, and none of the treated patients returned to any of our health system's EDs within 48 h following initial discharge.

Conclusions

The PFPB provided rapid and sustained pain reduction for ED patients with intractable paraspinal MPS. These preliminary findings support further prospective studies to validate the PFPB's efficacy and inform its implementation in emergency care.