Tanimoto Shota, Shakuo Tomoharu, Dosei Takuya, Sakamoto Atsunori, Shida Kenji
Anesthesiology, Showa University Northern Yokohama Hospital, Yokohama, JPN.
Cureus. 2024 Dec 9;16(12):e75406. doi: 10.7759/cureus.75406. eCollection 2024 Dec.
Flail chest is a life-threatening condition characterized by multiple rib fractures that result in a partially free rib cage. Thoracic paravertebral block (TPVB) allows visualization of the needle tip under ultrasound guidance and can be safely performed, unlike epidural anesthesia where the needle tip cannot be visualized. Here, we describe a case of flail chest in whom TPVB was used, as it provides the same level of analgesia as epidural anesthesia and has a perfect analgesic effect. A 58-year-old man with multiple rib fractures and a flail chest underwent emergency sternal fixation under general anesthesia with postoperative bilateral TPVB and catheter placement. The left side was difficult to puncture and thus required puncture twice. After TPVB, the patient was returned to the intensive care unit under intubation. On postoperative day 2, the catheter on the left side leaked a large amount of fluid and was removed. The patient was extubated on postoperative day 3. The right catheter was removed on postoperative day 5. The patient was discharged at 14 days postoperatively without complications. The patient reported no significant postoperative pain. TPVB may be a useful option with analgesic effects and reduced circulatory depression, particularly if epidural anesthesia cannot be performed with a flail chest.
连枷胸是一种危及生命的状况，其特征为多根肋骨骨折导致胸廓部分游离。胸椎旁神经阻滞（TPVB）可在超声引导下看到针尖，且能安全实施，这与硬膜外麻醉不同，硬膜外麻醉时看不到针尖。在此，我们描述一例使用TPVB的连枷胸病例，因为它能提供与硬膜外麻醉相同程度的镇痛效果，且具有完美的镇痛作用。一名58岁多根肋骨骨折并患有连枷胸的男性在全身麻醉下行急诊胸骨固定术，术后进行双侧TPVB及置管。左侧穿刺困难，因此需要穿刺两次。TPVB后，患者在插管状态下返回重症监护病房。术后第2天，左侧导管大量漏液，遂将其拔除。患者于术后第3天拔管。右侧导管于术后第5天拔除。患者术后14天出院，无并发症。患者报告术后无明显疼痛。TPVB可能是一种有用的选择，具有镇痛效果且能减轻循环抑制，特别是在连枷胸无法实施硬膜外麻醉的情况下。
