Bilateral Continuous Thoracic Paravertebral Block for the Pain Management of Multiple Rib Fractures With Flail Chest:...

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Pain Management

Background:

• Flail chest, a severe consequence of multiple rib fractures, presents significant pain management challenges.
• Epidural anesthesia is often limited in flail chest cases due to the inability to visualize the needle tip.
• Thoracic paravertebral block (TPVB) offers ultrasound guidance for precise needle placement.

Observation:

• A 58-year-old male with flail chest underwent sternal fixation and bilateral TPVB with catheter placement.
• Ultrasound guidance facilitated TPVB, though the left side required a second puncture.
• Postoperative complications included a left-sided catheter leak, necessitating its removal.

Findings:

• The patient was successfully extubated on postoperative day 3 and discharged on day 14.
• Bilateral TPVB provided excellent postoperative pain control with no significant pain reported.
• TPVB demonstrated comparable analgesia to epidural anesthesia with reduced circulatory depression.

Implications:

• TPVB is a viable and effective alternative for managing flail chest pain, especially when epidural anesthesia is contraindicated.
• Ultrasound-guided TPVB enhances safety and efficacy in thoracic trauma patients.
• This case highlights TPVB's potential for superior pain management and improved patient outcomes in flail chest.