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44 Retrolaminar paravertebral catheters for rib plating surgery – a case series
  1. EEL Ng,
  2. SX Ho,
  3. CHJ Ong,
  4. J Tan,
  5. LL Lean and
  6. W-S Choo
  1. Ng Teng Fong General Hospital, Singapore, Singapore


Background and Aims The ultrasound-guided retrolaminar technique to paravertebral blockade (RLB) is safe, easy and minimally invasive for use in mastectomies1, analgesia for rib fractures2, and analgesia post thoracic surgery3 with reduced risks of pneumothorax and structural injury and reduced spread of injectate. Though literature described higher volume boluses followed by infusions, we present our experience with in-plane ultrasound-guided RLB catheter using moderate volume boluses twice daily (BD) for rib fixations.

Methods Five cases of ultrasound-guided retrolaminar paravertebral block catheter were observed between May 2019 and March 2020 in our institution who sustained multiple rib fractures and underwent surgical fixation. Details of the patients are presented in tables 1–2.

Results Patients’ satisfaction is high – low pain scores shows that the degree of analgesia is more than adequate, with bolus duration exceeding the BD dosing. RLB confers a better safety profile (less invasive, lower risks of pneumothorax, bleeding or epidural spread) to classical blocks. Erector spinae blocks (ES) though effective4-5, have not been attempted for plating. Reasons for RLB catheter are: insertion point away from surgical site; ability for peri-op analgesia via a catheter; good mobility; minimal hypotension; minimal nursing care; surgical satisfaction and same benefits to ES catheters.Insertion of these catheters as part of a holistic analgesia plan, from pre-op to post-op, as well as comparing to ES blocks, should be considered.

Abstract 44 Table 1

Patients characteristics

Abstract 44 Table 2

Analgesia characteristics

Conclusions The RLB confers similar analgesic efficacy but also minimal interruption to surgery and reduced complications, thereby a viable option for rib fracture plating analgesia.

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