Ultrasound-guided continuous thoracic paravertebral analgesia with bupivacaine versus continuous intravenous morphine infusion for unilateral multiple fracture ribs

Abstract

Background Rib fractures are common, and pain from rib fractures can be difficult to control, particularly in first few days. This pain may affect the pulmonary functions, morbidity, and mortality. Objective The aim of this study was to compare and evaluate the efficacy of ultrasound-guided continuous thoracic paravertebral block (USG-TVPB) using bupivacaine versus continuous intravenous morphine infusion (IVMI) in pain relief for patients with unilateral multiple fractured ribs (UMFRs) and on pulmonary function improvement. Patients and methods The study included 70 ICU patients of both sexes, aged 18–60 years with ASA physical status class I to III who had unilateral three or more ribs fracture. According to the conducted method for relief of fracture rib pain, these patients were assigned into two equal groups with 35 patients in each. The first group patients (USG-TPVB) received ultrasound-guided thoracic paravertebral analgesia using bupivacaine. The second group patients (IVMI group) received intravenous morphine infusion. The recorded data included patients demographic variables, pain severity, pulmonary mechanics, arterial blood gases, hemodynamic changes, analgesic request/day, total rescue morphine analgesic dose, and total ketorolac dose over 4 days of ICU stay, and hospital stay durations, and adverse effects. Results After the start of analgesic regimen, the patients who received continuous thoracic paravertebral bupivacaine infusion (USG-TPVB group) were significantly better than those received continuous IV morphine infusion (IVMI group), where the forced vital capacity was significantly higher in USG-TPVB group than in IVMI group at 30 min, 24 h, and 48 h (P Conclusion Ultrasound-guided continuous thoracic paravertebral analgesia with bupivacaine provided better pain control with improved pulmonary functions than continuous systemic intravenous morphine analgesia in unilateral multiple rib fractures with less rescue analgesic requests, shorter length of ICU stay, and less adverse effects.