The Analgesic Effect of Retro-laminar Block Versus Paravertebral Block in Patients with Multiple Fracture Ribs

"Positioning~The patient is positioned in a lateral decubitus position with the affected side up. The patient's arm on the affected side is placed behind the head. The patient's spine is aligned and the shoulder is elevated to expose the paravertebral space.~\*Ultrasound imaging~A high-frequency linear ultrasound probe (5-12 MHz) is placed in a paramedian sagittal plane at the desired level of block. The probe is oriented so that the transverse processes are visualized on the lateral side of the screen and the vertebral laminae are visualized on the medial side of the screen. The interlaminar space is visualized as a hypoechoic region between the laminae.~\*Needle insertion~A short bevel block needle (20-22 G) is inserted through the skin at the caudal end of the ultrasound probe, aiming cephalad. The needle is advanced under real-time ultrasound guidance until the tip of the needle contacts the lamina. The needle is then slightly withdrawn and the local anesthetic is injected into t"

"* Patient Preparation~* Place the patient in the lateral decubitus position with the side of the block facing up.~* Position the patient's arm so that it is resting comfortably on the operating table.~* Prepare the skin over the block site with an antiseptic solution.~* Sterilely drape the area.~* Ultrasound Imaging~* Place the ultrasound probe in a transverse plane at the level of the desired block.~* Identify the following anatomical landmarks:~* Vertebral body~* Transverse process~* Pleura~* Intercostal space~* Needle Insertion~Use a sterile ultrasound-guided needle. Insert the needle in-plane from a lateral to medial direction, aiming for the apex of the paravertebral space.~The needle should be advanced until it is just beyond the transverse process.~\*Test Aspiration~Aspirate to ensure that the needle is not in a blood vessel.~* Local Anesthetic Injection~* Inject the local anesthetic slowly, aspirating frequently.~* The local anesthetic should be injected int"