Güntuğ BATIHAN

Evaluation of the Effectiveness of Intercostal Nerve Block for Pain Management in Patients with Traumatic Rib Fractures

Aim: Pain palliation is the most critical content of the treatment in traumatic rib fractures. The study aimed was to investigate the effect of including intercostal nerve block in the treatment of rib fractures on pain control. Material and Method: Patients treated for traumatic rib fractures in the thoracic surgery clinic of our center between February 2022 and June 2022 were evaluated retrospectively. The characteristics of the patients, their visual analogue scale scores, analgesic medication needs, and hospital stay were recorded. The data of the patients who underwent intercostal nerve blockade and those who were treated with standard analgesic medications were compared. Results: A total of 49 patients were included in the study. A total of 18 (36.7%) patients underwent daily intercostal nerve block. Standard pain treatment was applied to 31 (63.3%) patients. In the group of patients who underwent intercostal nerve blockade, the mean pain score on the third day and the mean need for nonsteroidal anti-inflammatory medication were significantly lower. Conclusion: In our study, the adding an intercostal nerve block to the treatment of rib fractures provided better pain control and reduced the need for analgesic medication.

Keywords:

chest trauma, intercostal nerve block rib fractures,

PDF

___

1.Flagel BT, Luchette FA, Reed RL, Esposito TJ, Davis KA, Santaniello JM, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005;138(4):717–23.
2. Kim M, Moore JE. Chest Trauma. Current recommendations for rib fractures, pneumothorax, and other injuries. Curr Anesthesiol Rep. 2020;10(1):61–8.
3. He Z, Zhang D, Xiao H, Zhu Q, Xuan Y, Su K, et al. The ideal methods for the management of rib fractures. J Thorac Dis. 2019;11(8):1078–89.
4. Ventafridda V, Saita L, Ripamonti C, De Conno F. WHO guidelines for the use of analgesics in cancer pain. Int J Tissue React. 1985;7(1):93–6.
5. Nair A, Diwan S. Efficacy of ultrasound-guided serratus anterior plane block for managing pain due to multiple rib fractures: a scoping review. Cureus. 2022;14(1):e21322.
6. Hwang EG, Lee Y. Effectiveness of intercostal nerve block for management of pain in rib fracture patients. J Exerc Rehabil. 2014;10(4):241–4.
7. Truitt MS, Murry J, Amos J, Lorenzo M, Mangram A, Dunn E, et al. Continuous intercostal nerve blockade for rib fractures: ready for primetime? J Trauma. 2011;71(6):1548–52.
8. Yetim TD, Yetim I, Duru M. Investigation of the effect of intercostal blockade in palliation of pain in patients with rib fracture. Turk Gogus Kalp Dama. 2012;20:287–90.
9. Sheets NW, Davis JW, Dirks RC, Pang AW, Kwok AM, Wolfe MM, et al. Intercostal nerve block with liposomal bupivacaine vs epidural analgesia for the treatment of traumatic rib fracture. J Am Coll Surg. 2020;231(1):150–154.
10. Baxter CS, Singh A, Ajib FA, Fitzgerald BM. Intercostal nerve block. 2022 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
11. Uhlich R, Kerby JD, Bosarge P, Hu P. Use of continuous intercostal nerve blockade is associated with improved outcomes in patients with multiple rib fractures. Trauma Surg Acute Care Open. 2021;6(1):e000600.