Thoracic Paravertebral Analgesia for Treatment Blunt Chest Trauma withMultiple Rib Fractures
2017
Multiple rib fracture (MRF) causes severe pain that compromise respiratory mechanics. We evaluated the efficacy
of thoracic paravertebral block with bupivacaine -fentanyl mixture in patients with unilateral MRF. The study was
carried out on 172 blunt chest trauma patients in prospective nonrandomized case series. An initial bolus dose of
0.3 ml/kg of bupivacaine 0.25% plus fentanyl 2 μg/ml was used following by continuous infusion with 0.1 ml/kg/h of
bupivacaine 0.125% plus fentanyl 2 μg/ml. Pain severity was assessed by visual analogue scale (VAS) at rest and
during coughing; bedside spirometry was measured 5 times in 3 consecutive days after paravertebral block. Traffic
accidents (69.1%) was major reason for blunt chest trauma; the number of ribs fracture ranged from 3-5 (76.1%) and
6-8 (23.9%). The rate of hemothorax, pneumothorax and the combination hemothorax-pneumothorax were 64.5%,
7.6% and 27.9% respectively. There was significant improvement in pain score at rest and during coughing,
respiratory rate, FVC and FEV1 (p<0.05) 30 min after initial bolus dose, which were sustained during continuous
thoracic paravertebral infusion 72 h (p<0.05). The rate of analgesic rescue by paracetamol infusion was 6.4%. No
patient had respiratory depression or respiratory failure or signs of local anesthetic toxicity. The result shows that
thoracic paravertebral analgesia with bupivacaine and fentanyl provided a good efficacy for pain management in
patients with unilateral MRF.
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