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Thoracic trauma constitutes 10-15% of all injuries, with rib fractures (RF) being common and painful. The intrathecal injection of morphine has been studied for patients with multiple RFs. If conditions are suitable for their use, the local anesthetics are the most efficacious mechanism for managing RF pain. Local anesthetics (sometimes co-administered with opioids) have also been used by the epidural administration route. This approach is associated with decreased pulmonary morbidity and mortality in patients older than 60 years of age with RF. For the majority of patients with RF, the controversy surrounding NSAIDs and delayed bone fracture healing is relevant. Used in patients with chest wall trauma, epidural analgesia produces pain relief that is superior to that produced by systemic opioids or other local anesthetic approaches. Local anesthetic administration via thoracic paravertebral block entails injecting an agent such as bupivacaine alongside the thoracic vertebrae.
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