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Multiple rib fracture (MRF) causes severe pain that compromise respiratory mechanics. We evaluated the efficacy of thoracic paravertebral block with bupivacaine -fentanyl mixture in patients with unilateral MRF. The study was carried out on 172 blunt chest trauma patients in prospective nonrandomized case series. An initial bolus dose of 0.3 ml/kg of bupivacaine 0.25% plus fentanyl 2 μg/ml was used following by continuous infusion with 0.1 ml/kg/h of bupivacaine 0.125% plus fentanyl 2 μg/ml. Pain severity was assessed by visual analogue scale (VAS) at rest and during coughing; bedside spirometry was measured 5 times in 3 consecutive days after paravertebral block. Traffic accidents (69.1%) was major reason for blunt chest trauma; the number of ribs fracture ranged from 3-5 (76.1%) and 6-8 (23.9%). The rate of hemothorax, pneumothorax and the combination hemothorax-pneumothorax were 64.5%, 7.6% and 27.9% respectively. There was significant improvement in pain score at rest and during coughing, respiratory rate, FVC and FEV1 (p<0.05) 30 min after initial bolus dose, which were sustained during continuous thoracic paravertebral infusion 72 h (p<0.05). The rate of analgesic rescue by paracetamol infusion was 6.4%. No patient had respiratory depression or respiratory failure or signs of local anesthetic toxicity. The result shows that thoracic paravertebral analgesia with bupivacaine and fentanyl provided a good efficacy for pain management in patients with unilateral MRF.