Bilateral Continuous Thoracic Paravertebral Block for the Pain Management of Multiple Rib Fractures With Flail Chest: A Case Report.

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.