Localizing the Pain: Continuous Paravertebral Nerve Blockade in a Patient with Acute Pancreatitis

Patient: Female, 41-year-old Final Diagnosis: Pancreatitis Symptoms: Abdominal pain • nausea • vomiting Medication: — Clinical Procedure: — Specialty: Anesthesiology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Acute pancreatitis is the leading gastrointestinal cause of hospitalization in the United States. The associated pain, for which opioids are commonly prescribed, can result in complications of respiratory dysfunction secondary to impaired abdominal wall movement. Paravertebral nerve blockade has shown substantial efficacy in treatment of abdominal and thoracic pain, but its utility for pancreatitis pain and role in reducing hospital length of stay and narcotic use has not been well studied. CASE REPORT: A 41-year-old woman with longstanding history of recurrent pancreatitis controlled with celiac plexus blocks and oxycodone was admitted for severe left upper quadrant abdominal pain. The patient was admitted, made NPO, and started on IV morphine. She underwent a left-sided T12-L1 paravertebral single shot injection and catheter placement, and experienced immediate relief. A Marcaine infusion was continued for 3 days and the patient required no additional narcotics while the catheter was in place. On hospital day 6, the catheter was removed and the patient was discharged. CONCLUSIONS: Our case illustrates the successful use of continuous thoracic paravertebral nerve blockade in a patient with pancreatitis. This intervention resulted in a significant reduction in narcotic requirements. As the number of hospitalizations and mean cost for acute pancreatitis has increased over the years despite an in-house mortality decrease, targeting cost reduction via length of stay reductions is key. Optimizing pain management in these patients is one way in which we can reduce LOS and thereby cost. We believe paravertebral nerve blockade is a viable analgesic option worth exploring in this patient population.