Comparison Thoracic Epidural and Intercostal Block to Improve Ventilation Parameters and Reduce Pain in Patients with Multiple Rib Fractures

Hashemzadeh, Shahryar; Hashemzadeh, Khosrov; Hosseinzadeh, Hamzeh; R, Aligholipour Maleki; Se, Golzari

doi:10.5681/jcvtr.2011.019

Cited by 14 publications

(3 citation statements)

References 17 publications

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“…They showed significant improvements in all patients regarding pain intensity and ABG indexes and also declared more improvements in intercostal blockade technique. [ 21 ] The same results were reported by Hofer et al . in 2015.…”

Section: Discussionsupporting

confidence: 84%

Comparing the effectiveness of bupivacaine administration through chest tube and intercostal blockage in patients with rib fractures

Yazdani¹,

Nasr-Esfahani²,

Kolahdouzan³

et al. 2022

Adv Biomed Res

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Background: There are several methods to control pain, especially in traumatic patients with rib fractures. Intrapleural analgesia (IPA) and intercostal block methods are recommended in patients with rib fractures to control pain. Here, we aimed to evaluate and compare the effects of IPA and intercostal block on patients’ clinical conditions. Materials and Methods: This is a randomized clinical trial that was performed in 2020–2021 on thirty traumatic patients with rib fractures. We collected the results of arterial blood gas in all patients before interventions including HCO3, pH, pO2, and pCO2 and also evaluated pain of patients. The first group underwent intercostal blockade with standard method with bupivacaine, and for the second group of patients, a chest tube was implanted. Patients were monitored for up to 12 h for pain intensity and need for analgesics. Results: The mean levels of HCO3 decreased in both groups after the interventions, and this decrease was more significant in patients in the intercostal blockade group ( P < 0.05). The mean levels of pO2 increased in both groups after interventions, especially in patients in the intercostal blockade group ( P < 0.05). The mean pCO2 levels also decreased in both groups ( P < 0.05). The mean pain intensity in both groups decreased significantly after the intervention ( P < 0.05) and also the mean pain intensity in the intercostal blocking group decreased significantly more than the group treated with chest tube ( P < 0.05). Conclusion: Intercostal blockade through bupivacaine is more effective than chest tube administration of bupivacaine in patients with rib fractures.

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Section: Discussionsupporting

confidence: 84%

Comparing the effectiveness of bupivacaine administration through chest tube and intercostal blockage in patients with rib fractures

Yazdani¹,

Nasr-Esfahani²,

Kolahdouzan³

et al. 2022

Adv Biomed Res

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show abstract

“…In a study by Hashemzadeh et al 25 comparing 30 patients treated with thoracic epidurals with bupivacaine 0.125% + 1 mg/5 ml morphine to 30 patients treated with intercostal blocks with 0.25% bupivacaine, it was found that pain scores for the epidurals were significantly lower days 1 to 3 after the epidural (P < .004). A meta-analysis by Peek et al 26 comparing epidural to other forms of pain management such as intravenous analgesia, paravertebral blocks (PVBs) and intercostal blocks demonstrated that epidural analgesia provided significantly better pain relief compared to other forms of pain management.…”

Section: Epiduralsmentioning

confidence: 99%

Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians

Rogers

Larson

Rhone

et al. 2023

J Intensive Care Med

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Rib fractures are present in 15% of all traumas and 60% of patients with chest traumas. Rib fractures are not life-threatening in isolation, but they can be quite painful which leads to splinting and compromise of respiratory function. Splinting limits the ability of a patient to take a deep breath, which leads to atelectasis, atelectasis to poor secretion removal, and poor secretion removal leads to pneumonia. Pneumonia is the common pathway to respiratory failure in patients with rib fractures. It is noted that in the elderly, each rib fracture increases developing pneumonia by 27% and the risk of dying by 19%. From a public health perspective, rib fractures have long-term implications with only 59% of patients returning to work at 6 months. In this review we will examine the state of art as it currently exists with regard to the management of pain associated with rib fractures. Included in this overview will be a brief review of the anatomy of the thorax and some important physiologic concepts, the latest trends in pharmacologic and noninvasive means of managing rib pain, a special section on epidural anesthesia, some other alternative invasive methods of pain control, and a review of the recent literature on rib plating. Finally, a practical, easy to follow guideline, to manage the patient with pain from rib fractures will be presented.

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“…Similarly, a study comparing epidural analgesia to paravertebral analgesia among elderly patients with traumatic rib fractures did not find any difference in pain reduction between the groups, even after grouping the outcomes according to the number of fractures (p = 0.65, 0.78, and 0.29 for patients with two, three to five, and 6-12 rib fractures, respectively) [ 33 ]. However, there is evidence that TEA may provide more pain relief for rib fractures than intercostal blocks [ 34 ]. Furthermore, regional anesthesia seems more effective than parenteral opioids in patients with other injuries, such as hip fractures [ 35 ].…”

Section: Reviewmentioning

confidence: 99%

Comparative Analysis of Intravenous Opioids Versus Thoracic Epidural Anesthesia in Fractured Rib Pain Management: A Systematic Review and Meta-Analysis

Mohamed,

Elmoheen,

Bashir

et al. 2024

Cureus

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Rib fractures, common among trauma victims, lead to significant morbidity and mortality. Managing the associated pain is challenging, with IV opioids and thoracic epidural analgesia (TEA) being utilized. While epidural analgesia is often preferred for fractured rib pain, existing data encompasses both lumbar and thoracic approaches. This review aimed to compare TEA and IV opioids for persistent rib fracture pain. A comprehensive search across five databases yielded 987 articles, of which seven met the eligibility criteria. Outcomes were categorized into primary (pain reduction) and secondary (mortality, hospital/ICU stays, analgesia-related complications) endpoints. Analyzed with Review Manager (RevMan) Version 5.4.1 (2020; The Cochrane Collaboration, London, United Kingdom), the pooled data from two sources showed TEA significantly more effective in reducing pain than IV opioids (standardized mean difference ( SMD): 2.23; 95%CI: 1.65-2.82; p < 0.00001). Similarly, TEA was associated with shorter ICU stays (SMD: 0.73; 95%CI: 0.33-1.13; p = 0.0004), while hospitalization duration showed no substantial difference (SMD: 0.82; 95%CI: -0.34-1.98). Mortality rates also did not significantly differ between TEA and IV opioids (risk ratio (RR): 1.20; 95%CI: 0.36-4.01; p = 0.77). Subgroup analysis revealed fewer pneumonia cases with TEA (RR: 2.06; 95%CI: 1.07-3.96; P = 0.03), with no notable disparities in other complications. While TEA's superiority in pain relief for rib fractures suggests it is the preferred analgesic, the recommendation's strength is tempered by the low methodological quality of supporting articles.

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Comparison Thoracic Epidural and Intercostal Block to Improve Ventilation Parameters and Reduce Pain in Patients with Multiple Rib Fractures

Cited by 14 publications

References 17 publications

Comparing the effectiveness of bupivacaine administration through chest tube and intercostal blockage in patients with rib fractures

Comparing the effectiveness of bupivacaine administration through chest tube and intercostal blockage in patients with rib fractures

Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians

Comparative Analysis of Intravenous Opioids Versus Thoracic Epidural Anesthesia in Fractured Rib Pain Management: A Systematic Review and Meta-Analysis

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