Parascapular Sub Iliocostalis Plane Block Versus Thoracic Paravertebral Plane Block for Traumatic Multiple Rib Fractures

Pain control of rib fractures is essential for not only primary pain relief but also preventing secondary complications such as atelectasis or pneumonia which increase the hospital stay, as well as the transition to chronic pain. The cornerstones of analgesic management are oral and intravenous medications such as paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids as well as regional block techniques as paravertebral block and thoracic epidural. To avoid opioid as well as regional block related side effects such as pneumothorax and hemodynamic instability, previous studies showed that superficial chest wall block such as thoracic erector spinae plane block and serratus anterior plane block had shown a promising success in management of such pain with few side effects. In an effort to reduce the pain score, hospital stay and improve the patient's capability of physiotherapy this study compares continuous block of parascapular sub-iliocostalis plane block versus continuous thoracic paravertebral block for analgesia in patients with traumatic multiple rib fractures.

Inclusion Criteria: * Patient written informed consent. * ASA I to III. * Age 21-60 years old. * Gender: Both. * BMI \< 35 Kg/M2. * Accepted mental state of the patient. * Patient with unilateral multiple rib fractures (≥2 fractures) Exclusion Criteria: * Any trauma in the patient that interfere with the positioning of patients for block. * Patients who needed mechanical ventilation before or during the study. * Patients with associated head trauma. * Patient with hemodynamic instability and need inotropic support. • Patient with abbreviated injury scale (AIS) in extremity more than 2 (10) * Pathological coagulopathy. * Infection at the injection site. * Disturbed conscious level. * An allergy to local anesthetics or any used drugs in this study. * Pregnancy.