Continuous paravertebral block for pain relief in unilateral multiple rib fracture: A case series

Summary 

Rib fracture secondary to blunt chest trauma is an indicator of the severity of injury. It is one of the factors associated with morbidity and mortality in blunt chest trauma. Current management of such patients stresses on provision of adequate analgesia and early institution of aggressive physiotherapy. The current study evaluates the analgesic efficacy of continuous thoracic paravertebral infusion of Bupivacaine in unilateral multiple rib fracture (MRF).

Study design

Retrospective, non-randomized case series of 11 patients with unilateral MRF.

Method

Thoracic paravertebral (TPV) space on the side of fractured ribs was catheterized with an epidural catheter. TPV block was initiated with 0.3ml/kg body weight of 0.25% Bupivacaine with adrenaline. The block was maintained with a continuous infusion of 0.2% Bupivacaine 30min later, at 0.1–0.2ml/(kg/h) for a total of 4 days or for the length of admission, which ever was earlier.

Patients were monitored for pain scores at rest and when asked to cough and vital capacity manoeuvre, respiratory rate, oxygen saturation, oxygen index (PaO₂/FiO₂) and percentage change in incentive spirometry.

There were significant improvements in pain scores at rest (p=0.0097), on cough (p=0.0039) and vital capacity manoeuvre (p=0.0078). Other respiratory parameters like respiratory rate, PaO₂ and oxygen index showed persistent improvement from baseline. None of the patients had any complications or side effect related to procedure and technique.

Conclusion

Our study confirms that continuous TPV block is a safe and effective technique for analgesia in patients with unilateral MRF.

Keywords: Paravertebal analgesia, Analgesic technique, Multiple rib fracture, Continuous regional analgesic technique, Bupivacaine infusion