Thoracic paravertebral block in multiple rib fractures for improved recovery and early mobility: a prospective study

Abstract

Objective: Multiple rib fractures are associated with significant pain, impaired respiratory function, and increased risk of complications. To assess the impact of the thoracic paravertebral block on pain control, respiratory function, early ambulation, opioid consumption, and complication rates in patients with multiple unilateral rib fractures. Methods: This prospective, randomized controlled study was conducted at a tertiary trauma center. Eighty adult patients with ≥3 unilateral rib fractures were randomly assigned to two groups: Group A received thoracic PVB with local infiltration into the respective ICS, and Group B received standard systemic analgesia using intravenous opioids and NSAIDs. Results: Patients in Group A experienced significantly lower pain scores at all-time points (mean VAS at 72h: 2.1 vs 4.2, p<0.001). Incentive spirometry volumes improved more in Group A (1120 mL vs 880 mL, p<0.001). Time to ambulation was shorter (28.6 vs 42.4 hours, p<0.001), and opioid consumption was nearly halved (18.3 mg vs 36.9 mg morphine equivalent, p<0.001). Pulmonary complications were less frequent in Group A (atelectasis: 7.5% vs 25%, p=0.03). ICU and hospital stays were significantly shorter, and patient satisfaction scores were higher in the PVB group (p<0.001). Conclusion: It is concluded that paravertebral block provides superior pain relief, improves respiratory mechanics, accelerates early mobility, and reduces complications and hospital stay in patients with multiple rib fractures. Incorporating PVB into trauma care pathways offers a safe, effective, and patient-centered approach to rib fracture management.