The purpose of this paper is to describe a paravertebral approach that provides accurate localization of the needle in relation to the nerve for anesthetic blocking of the thoracic and lumbar spinal nerves. The technique can be termed the medial route for paravertebral somatic nerve blocking. It depends on contacting the lamina of the vertebra at the level of the intervertebral foramen and then redirecting the needle laterally and anteriorly to approach the intercostal or lumbar nerve. The principal techniques in use at present depend on utilization of a rib or transverse process as the major landmark. In one technique 1 the rib (or in the lumbar region, the transverse process) below the nerve is contacted 4 cm. from the midline and the needle is then redirected cephalad, medially, and anteriorly to parallel the course of the spinal nerve. If the needle deviates even slightly from the proper direction, the