Background: Paravertebral block is often used to provide postoperative analgesia after renal surgery. In this case-series report, we present our experience with 3 patients in whom percutaneous nephrolithotomy was performed successfully under ultrasound-guided 3-segment lumbar-thoracic paravertebral block. Case summary: Three patients were scheduled for percutaneous nephrolithotomy. All 3 patients were high-risk cases for both general and neuraxial anesthesia. After due deliberation and with the consent of patient and his family, ultrasound-guided paravertebral block was performed. Seven to 10mL of 0.5% ropivacaine was injected at T10/T11, T11/T12, and T12/L1 paravertebral place, respectively. Sensory loss to pinprick from T8 to L2 was achieved in all 3 patients 20 min after administration of block. Surgical procedures for all 3 patients were successful, and none of the patients complained of pain during the operation. Conclusions: Ultrasound-guided multilevel paravertebral block may be an attractive option for anesthetic management of percutaneous nephrolithotomy in clinical practice.