Continuous thoracic paravertebral blockade: A case report and review of technique

Multiple rib fractures cause severe pain. When this pain is combined with suboptimal analgesia it can impact significantly on respiratory function and lead to respiratory compromise and complications. Effective analgesia is required to allow a patient to cough, take deep breaths and participate in physiotherapy. Systemic opioids are commonly used but can result in inadequate pain control and respiratory depression. Epidural analgesia is often preferred over systemic opioids, but is contraindicated in a number of patients. This paper describes the case of an opioid dependent patient suffering from multiple rib fractures complicated by coagulopathy, hypovolaemia and acute on chronic hepatic and renal failure. Analgesia was provided with a continuous thoracic paravertebral block (c-TPVB).