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#36484 Thoracic paravertebral block as analgesic method in a patient with multiple rib fractures
  1. Grigorios Belivanakis1,
  2. Georgios Ntontos2,3,
  3. Chryssa Pourzitaki1,4,
  4. Vasilios Vasilopoulos5,
  5. Emmanouil Ganitis5 and
  6. Eleni Logotheti5
  1. 1Anaesthesiology Department and Pain Medicine, ‘Anassa’ General Clinic, Volos, Greece
  2. 2Cardiothoracic surgeon, ‘Anassa’ General Clinic, Volos, Greece
  3. 3Cardiothoracic Surgeon, Interbalkan Medical Center, Thessaloniki, Greece
  4. 4Clinical Pharmacology Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
  5. 5Anaesthesiology Department and Pain Medicine, General Hospital of Volos, Volos, Greece


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Background and Aims A 72 years old, male patient with fractures in 6 consecutive ribs, three of which in multiple places, arrived at the ER ward, after a fall from a ladder. The CT scanning revealed no pneumothorax or hemothorax. The patient complained about severe chest pain, shortness of breath, progressively getting worse. At the same time, tachypnea, intense sweating, hypertension and tachycardia were clinically observed.

Methods To relieve the patient, it was decided to perform a thoracic paravertebral block at two levels, in one of which a continuous drug infusion catheter was placed. A PCRA pump was used and the patient was immediately relieved. He was transferred to the PACU due to the severity of his injury and remained there for two days.

Results Being respiratory stable and in good clinical condition, he was transferred to a simple ward and after 4 more days, without presenting any complications, it was decided to remove the catheter. The patient was then treated with mild analgesics such as paracetamol and tramadol and a week later he left the hospital, presenting a satisfactory and stable clinical condition and instructions for p.o analgesia.

Conclusions To our knowledge this was the first time that a paravertebral block was used as an analgesic method for multiple rib injuries. In our patient the thoracic paravertebral block was probably the cause of the non-appearance of the expected respiratory complications (hypoxemia, atelectasis, respiratory failure, pneumonia, intubation, hospitalization in the ICU) and contributed to the rapid recovery of his severe injuries.

  • rib fractures
  • thoracicparavertebral block
  • analgesia

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