title: Continuous thoracic paravertebral nerve block in a working anesthesia resident-when opioids are not an option.
abstract: Multiple unilateral rib fractures can cause significant pain and morbidity. Continuous nerve block catheters are often maintained while inpatient, and patients are discharged with oral analgesics. However, in many institutions, this dynamic is changing and patients are being managed effectively with outpatient catheters. A 45-year-old male was presented with fractured right ribs 6 through 9. The patient was an anesthesiology resident and was unable to perform his clinical duties. Single paravertebral nerve blocks were performed at right thoracic levels 6-9. At the T7 level, an indwelling catheter was placed. On post-injury day 18, he was able to discontinue the catheter and there were no associated complications. We report a unique case of a patient with multiple rib fractures who was not able to be exposed to potential side effects of opioids. The use of a continuous thoracic paravertebral nerve in an outpatient setting allowed a faster return to function with no adverse events.
authors.affiliation: Army Regional Anesthesia & Pain Management Initiative, Anesthesia & Operative Service, Walter Reed Army Medical Center, Building 2, Ward 44, Room 4418, Washington, DC 20307-5001, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Buckley
authors.forename: Hisani
authors.initials: H
authors.lastname: Edwards
authors.forename: Chester C
authors.initials: CC
authors.lastname: Buckenmaier
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Plunkett
mesh_terms: D000701:Analgesics, Opioid; D000776:Anesthesiology / Q000193:education; D001642:Bicycling / Q000293:injuries*; D002408:Catheters, Indwelling; D000075202:Contraindications; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D012253:Rib Fractures / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid