Thoracic paravertebral block for management of pain associated with multiple fractured ribs in patients with concomitant lumbar spinal trauma

Background and Objectives: The need for continual neurological assessment i n patients with lumbar spinal injury poses a challenge for effective manage ment of pain associated with multiple fractured ribs. Two cases are present ed to illustrate the benefits of using thoracic paravertebral block to cont rol the pain of multiple fractured ribs without compromising the ongoing ne urological assessment. Case Report: Thoracic paravertebral block was used in 2 patients with conco mitant multiple fractured ribs and lumbar spinal injury. Case 2 also had a head injury and there was moderate coagulopathy. The thoracic paravertebral catheter was placed in the upper thoracic region and radiological imaging was used to delineate spread before the injection of relatively small volum es (10 to 15 mL) of local anesthetic. In case 1, the thoracic paravertebral block produced ipsilateral segmental thoracic anesthesia, providing excell ent pain relief for the fractured ribs. It also spared the lumbar and sacra l nerve roots, preserving neurological function in the lower extremities an d bladder sensation. In case 2, effective analgesia without systemic sedati on and opioids resulted in the patient regaining consciousness, which allow ed continuous assessment of central and peripheral neurological function. Conclusion: Thoracic paravertebral block is an option for managing pain ass ociated with multiple fractured ribs in the presence of concomitant lumbar spinal injury requiring continual neurological assessment.