Successful management of pleuritic pain with thoracic paravertebral block

Background and Objectives: Thoracic paravertebral block (TPVB) is a unilate ral analgesic technique that has been advocated in both acute and chronic t horacic and abdominal pain. Other blocks such as interpleural and epidural can be effectively used in pleuritic pain. This report illustrates that TPV B could also be effective fur this kind of pain. Methods: A 45-year-old man with acute pancreatitis was referred to the crit ical care unit 11 days after emergency admission with severe left pleural e ffusion and acute respiratory failure. His medical history revealed hyperte nsion and chronic obstructive pulmonary disease (COPD): in addition, he was a heavy drinker and smoker. A pleuritic pain that only slightly improved w ith nonopioid analgesics and opioids resulted in the patient's increasing i nability to eliminate bronchial secretions. In an attempt to avoid endotrac heal intubation. the pain unit recommended a continuous paravertebral block . The block was performed at T9 on the left side. An initial bolus of 15 mt bupivacaine 0.25% was administered and a continuous infusion, initially at 5 mL/h. was increased up to 10 mL/h to achieve the desired analgesic effec t. Results: After the block the verbal analogue scale decreased from 9 to 3. a nd this level of pain relief was maintained until the end of the treatment 48 hours after the block. The patient improved and was discharged to the wa rd without the need for endotracheal intubation. Conclusions: This case report supports the notion that, in practice, the pa ravertebral block could be an effective and safe alternative to relief of p leuritic pain.