The autonomic nervous system consists of the sympathetic and parasympathetic divisions. The sympathetic nervous system is activated in situations requiring immediate bodily responses and is involved in pain modulation and certain pathological conditions. Pain syndromes with a suspected sympathetically mediated component may benefit from blocking the associated sympathetic nerves. Hence, interventions are targeted toward the paravertebral sympathetic chain to manage various pain-related disorders. While traditional landmark-based methods were initially employed, advancements in imaging techniques such as fluoroscopy and ultrasound imaging have enhanced visualization and improved the precision of these injections. This chapter offers a detailed overview of the relevant anatomy, clinical indications, contraindications, and ultrasound-, fluoroscopy-, and computed tomography-guided techniques used to perform blocks, such as stellate ganglion, lumbar sympathetic, celiac plexus, superior hypogastric plexus, and ganglion impar blocks.