PEF-Block & Ribs Fractures

"Group 1 control:~* Morphine titration at 0.1 mg/kg~* Establishment of PCA morphine:~* concentration 1mg/ml~* 1ml bolus~* refractory period of 7 minutes~* no maximum dose per day. Premedication of the patient with Ketamine 0.15 mg/kg and Propofol 0.5 mg /kg"

"Group 2 PEF block:~* Establishment of PCA morphine:~* concentration 1mg / ml~* 1ml bolus~* refractory period of 7 minutes~* no maximum dose per day.~* Realization of a block of the posterior exo-thoracic fascia (PEF block) at the median level of ribs fractures with ropivacaine 5mg / mL, 3 mg / kg under echography guidance. ALR needle (type neurostimulation) with a length of 100 mm is used. When the injection is performed an analgesia catheter is deposited in the space created by local anesthetics. Realization of ropivacaine bolus 2mg / ml at 0.1ml/kg every 4 hours. Possibility of an additional bolus of 0.1ml / kg every hour if insufficient analgesia."

"Group 3 paravertebral block:~* Establishment of PCA morphine:~* concentration 1mg / ml~* 1ml bolus~* refractory period of 7 minutes~* no maximum dose per day.~* Realization of a paravertebral block (BPV) at the median level of ribs fractures ropivacaine 5mg / mL, (0.3ml / kg) 1.5 mg / kg under echography guidance. ALR needle (type neurostimulation) with a length of 100 mm is used. When the injection is performed an analgesia catheter is deposited in the space created by local anesthetics. Realization of bolus of ropivacaine 2mg / ml at 0.1ml / kg every 4 hours.~Possibility of an additional bolus of 0.1ml / kg every hour if insufficient analgesia.~In the case of failure of initial management with significant pain despite the iterative boli, epidural analgesia is used in recourse."