This case report describes a modified approach for a thoracic paravertebral block by performing a bilateral ultrasound-assisted injection of 12 mL of 0.5%
levobupivacaine near the thoracic intervertebral foramen, combined with
general anesthesia, in a patient who underwent emergent
laparotomy for small
intestinal volvulus. Two continuous
catheter sets were used for a bilateral continuous block with
levobupivacaine 0.25% at a rate of 5-8 mL/h. No complications during the execution of the block were recorded. No supplemental
opioids were administered and the patient was hemodynamically stable, requiring no pharmacological cardiovascular support during surgery. At the end of the
surgical procedure, the patient received a continuous flow of 0.2%
levobupivacaine as postoperative
analgesia, at a basal flow of 4 mL/h per each side, a bolus of 4 mL, and a lockout time of 60 min was used. The
postoperative pain on the Numeric Rating Scale was 2 at rest and it was 4 in motion, without neurological or respiratory sequelae due to block in the first 72 h after surgery.