Subpleural block in patients with multiple rib fractures.

Multiple rib fractures result in agonizing pain as well as impaired pulmonary functions. Mechanical ventilations are frequently indicated for those with poor respiratory reserves. Regional anesthesia has been advocated for easing pain and discomfort. We evaluate the efficacy of subpleural block in the treatment of multiple rib fractures. Ten patients who sustained multiple rib fractures were observed on the arrival of emergent service. One sustained flailed chest with respiratory distress which necessitated mechanical ventilation in intensive care unit. Subpleural block with 20 ml 0.5% bupivacaine was done to each patient. The location of catheter was identified by the injection of contrast medium. Serial visual analogue pain scale, arterial blood gas, and pulmonary function test were taken before and after subpleural block. Pulmonary function test significantly improved after subpleural block. Pain relief was immediate and desirable. The case in ICU weaned from ventilator 3 days later. There were no major complications after subpleural block. Inadvertent epidural spread and recurrent laryngeal nerve blocks were detected both clinically and radiologically without sequela noted. Subpleural block is effective both in pain relief and in improving pulmonary functions. Image intensifier is essential to subpleural block in order to prevent the misplacement of catheter. We recommend subpleural block to be an alternative approach of regional anesthesia in patients with multiple rib fractures.