Background and Aims:

Rib fractures incur significant pain and morbidity. Ultrasound-guided thoracic paravertebral (PVB) analgesia has been described in the management of rib fractures, but little published evidence exists beyond case studies and small case series.

Methods:
Patients are managed according to a blunt chest trauma protocol which involves anaesthetic review and consideration of PVB. All PVBs are recorded on a database, which includes complications and reasons for removal. This was retrospectively analysed from the 4 years since inception of the database with corresponding national trauma audit (TARN) data from all patients with rib fractures admitted to our institution.

Results
A total of 314 consecutive PVB were received by 290 patients. The following complications were observed; 5 patients (1.5%) recieved ineffective analgesia, 39 catheters (12%) were unitentionally disconnected, 1 infusion was stopped due to metalic taste, 1 inconsequential pleural puncture. Multivariate regression of TARN outcome data demonstrates a statistically significant reduction in mortality associated with PVB, but this becomes non-significant as a time-dependent covariate.

Conclusions:
PVB was a safe and effective treatment for rib fractures, but there is insufficient evidence to confirm a mortality benefit.

ESRA-2018