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Date Published: 05/11/2020
Abstract Views: 424
Views PDF: 329
DOI: https://doi.org/10.47972/vjcts.v22i.413
Issue
Vol. 22
Section
Research Article
How to Cite
Nghia, D. T., Trung, N. N., Nam, N. V. ., Binh, T. T., Anh, V. A. ., Hau, L. H., Khanh, N., Nguyen, P. D., Kien, N. T. ., & Giang, N. T. (2020). Thoracic paravertebral analgesia for treatment blunt chest trauma with multiple rib fractures. The Vietnam Journal of Cardiovascular and Thoracic Surgery, 22, 13-18. https://doi.org/10.47972/vjcts.v22i.413

Thoracic paravertebral analgesia for treatment blunt chest trauma with multiple rib fractures

Dang Tuan Nghia, Nguyen Ngoc Trung, Nguyen Van Nam, Tran Thanh Binh, Vu Anh Anh, Lai Hop Hau, Nguyen Khanh, Phan Duy Nguyen, Nguyen Trung Kien, Nguyen Truong Giang

Main Article Content

Abstract

The study was carried out on 172 blunt chest trauma patients in prospective nonrandomized case series. An initial bolus dose of 0.3 ml/kg of bupivacaine 0.25% plus fentanyl 2 μg/ml was used following by continuous infusion with 0.1 ml/kg/h of bupivacaine 0.125% plus fentanyl 2 μg/ml. Pain severity was assessed by visual analogue scale (VAS) at rest and during coughing; bedside spirometry was measured 5 times in 3 consecutive days after paravertebral block. Traffic accidents (69.1%) was major reason for blunt chest trauma; the number of ribs fracture ranged from 3-5 (76.1%) and 6-8 (23.9%). The rate of hemothorax, pneumothorax and the combination hemothorax-pneumothorax were 64.5%, 7.6% and 27.9% respectively. There was significant improvement in pain score at rest and during coughing, respiratory rate, FVC and FEV1 (p<0.05) 30 min after initial bolus dose, which were sustained during continuous thoracic paravertebral infusion 72 h (p<0.05). The rate of analgesic rescue by paracetamol infusion was 6.4%. No patient had respiratory depression or respiratory failure or signs of local anesthetic toxicity. The result shows that thoracic paravertebral analgesia with bupivacaine and fentanyl provided a good efficacy for pain management in patients with unilateral MRF.

Article Details

Keywords

chest trauma, thoracic paravertebral analgesia, multiple rib fracture.

References

1. Cheema, S. P., D. Ilsley, J. Richardson, and S. Sabanathan, (1995), "A thermographic study of paravertebral analgesia". Anaesthesia. 50(2), 118-21.
2. Davies, R. G., P. S. Myles, and J. M. Graham, (2006), "A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta- analysis of randomized trials". Br J Anaesth. 96(4), 418-26.
3. Fibla, J. J., L. Molins, J. M. Mier, A. Sierra, D. Carranza, and G. Vidal, (2011), "The efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery: a randomized trial". Eur J Cardiothorac Surg. 40(4), 907-11.
4. Gabram, S. G., R. J. Schwartz, L. M. Jacobs, D. Lawrence, M. A. Murphy, J. S. Morrow, J. S. Hopkins, and R. F. Knauft, (1995), "Clinical management of blunt trauma patients with unilateral rib fractures: a randomized trial". World J Surg. 19(3), 388-93.
5. Galvagno, S. M., Jr., C. E. Smith, A. J. Varon, E. A. Hasenboehler, S. Sultan, G. Shaefer, K. B. To, A. D. Fox, D. E. Alley, M. Ditillo, B. A. Joseph, B. R. Robinson, and E. R. Haut, (2016), "Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society". J Trauma Acute Care Surg. 81(5), 936-951.
6. Hashemzadeh, S., K. Hashemzadeh, H. Hosseinzadeh, R. Aligholipour Maleki, and S. E. Golzari, (2011), "Comparison thoracic epidural and intercostal block to improve ventilation parameters and reduce pain in patients with multiple rib fractures". J Cardiovasc Thorac Res. 3(3), 87-91.
7. Karmakar, M. K. and A. M. Ho, (2003), "Acute pain management of patients with multiple fractured ribs". J Trauma. 54(3), 615-25.
8. Karmakar, M. K., P. T. Chui, G. M. Joynt, and A. M. Ho, (2001), "Thoracic paravertebral block for management of pain associated with multiple fractured ribs in patients with concomitant lumbar spinal trauma". Reg Anesth Pain Med. 26(2), 169-73.
9. Karmakar, M. K., L. A. Critchley, A. M. Ho, T. Gin, T. W. Lee, and A. P. Yim, (2003), "Continuous thoracic paravertebral infusion of bupivacaine for pain management in patients with multiple fractured ribs". Chest. 123(2), 424-31.
10. Mostafa Kamel and Amr Abdelfatah, (2010), "Pain mamagement in blunt chest trauma". Ain Shams Journal of Anesthesiology. 3(1), 89-96.
11. Richardson, J., P. A. Lonnqvist, and Z. Naja, (2011), "Bilateral thoracic paravertebral block: potential and practice". Br J Anaesth. 106(2), 164-71.
12. Simon, B. J., J. Cushman, R. Barraco, V. Lane, F. A. Luchette, M. Miglietta, D. J. Roccaforte, R. Spector, and East Practice Management Guidelines Work Group, (2005), "Pain management guidelines for blunt thoracic trauma". J Trauma. 59(5), 1256-67.