Effectiveness of intercostal nerve block for management of pain in rib fracture patients

Hwang, Eun Gu; Lee, Yun‐Jung

doi:10.12965/jer.140137

Cited by 40 publications

(30 citation statements)

References 8 publications

(9 reference statements)

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“…The primary treatment goal for rib fracture is pain relief. This is mainly achieved with the use of oral nonsteroidal anti-inflammatory drugs; however, in some cases, opioids or more aggressive methods like intercostal nerve block (ICNB) (Hwang and Lee, 2014) and epidural or intravenous patient-controlled analgesia are used. The second goal is to prevent pulmonary complications like atelectasis and pneumonia through effective pain management.…”

Section: Introductionmentioning

confidence: 99%

When will pulmonary function recover after rib fracture?

Hwang

Lee

2020

J Exerc Rehabil

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Rib fracture is almost recovered with conservative management including oral medication. Pain is easily controlled with medication, but physiologic function is not readily evaluated. This study is aimed to investigate the factors influencing to recovery of pulmonary function test (PFT) and changes according to times after rib fracture. From August 2015 to January 2018, medical records of patients with rib fracture were reviewed retrospectively. Factors may influencing to recovery of PFT (age, chronic obstructive pulmonary disease, numbers of fractures, intercostal nerve block) were evaluated, and serial (initial, 1 month, 2 months) changes of parameters PFT (forced vital capacity [FVC], forced expiratory volume in 1 sec [FEV1], total lung capacity [TLC], vital capacity [VC]) for 2 months were observed. Total patients were 60, and PFT was completed 38 and 27 patients after 1 month and 2 months respectively. Mean age was 55.1 years (20-84 years) and mean numbers of fracture were 3.98 (1-11). Intercostal nerve block and rib fixation were performed in 32 cases and 2 cases respectively. Age, numbers of fracture and intercostal nerve block were not significant factors to changes of PFT. But chronic obstructive pulmonary disease was significant factor to recovery of FEV1 in 1 month. PFT was improved in FVC, FEV1 through 2 months, and improved in TLC, VC in 1 month. This study showed the evidence and prognosis of physiologic recovery after rib fracture. And we could tell about physiologic recovery to rib fracture patients with this study.

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Section: Introductionmentioning

confidence: 99%

When will pulmonary function recover after rib fracture?

Hwang

Lee

2020

J Exerc Rehabil

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“…Narcotics, anti-inflammatory analgesics, epidural analgesia, and intercostal blockade are used to control the pain. By proper pain management, we can relieve the pain and discomfort due to fractured ribs, as well as reduce the incidence of complications (18). In our study, the pain was successfully controlled with intravenous opioid or epidural analgesia.…”

Section: Discussionmentioning

confidence: 76%

Clinical Analysis of the Correlation Between Rib Fractures and Prognosis in Multiple Trauma Patients

Hashemzadeh¹,

Kermani²,

Kakaei³

et al. 2018

Trauma Mon

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Background: Thoracic trauma is an important cause of morbidity and mortality in trauma patients and rib fracture due to blunt trauma to the chest wall is the most common etiology. Objectives: This study analyzed the correlation between rib fractures and prognosis in multiple trauma patients. Methods: One hundred eighty-four trauma patients suffering from rib fracture due to the blunt trauma were studied. Demographic data, injury characteristics, rib fracture characteristics, the associated injuries, and injury severity score (ISS) were recorded. The rib fracture was classified according to location (left, right, and bilateral) and level (upper [1st -2nd rib], middle [3rd -8th rib], and lower [9th -12th rib]); it also was categorized as lateral and posterolateral. Results: The rib fractures were posterolateral (69.6%), lateral (30.4%), upper (4.3%), middle (92.4%), and lower (3.3%). Patients with posterolateral fracture had significantly more complications leading to airway intubation and more intensive care support, higher ISS, associated with pelvic and clavicular fracture. Upper rib fractures were associated with more length-of-stay (LOS) while lower rib fractures were associated more with abdominal trauma and lumbar/thoracolumbar vertebral fractures. A significant positive correlation was seen between the number of fractured ribs and ISS, hospital, and ICU LOS. There were no complications during a two-month follow-up. Conclusions: Upper rib fractures are associated with severe traumas requiring more hospitalization and ICU support due to the more surgical and medical complications. Morbidity is higher in posterolateral fractures and these patients need more medical care.

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“…Thoracostomy tube were placed for patients with hemothorax or pneumothorax. For intercostal blockage, we used the method defined by Moonre and Bridenbaugh, which the radiologically targeted intercostal interval was determined and local anesthetic was administered to the intercostal targeted area [10]. Multimodal analgesic treatment was started in surveillance only group [8,11].…”

Section: Methodsmentioning

confidence: 99%

Pain Managment of Multiple Rib Fractures on the Basis of Early Reduction and Fixation in Patients without Intensive Care Unit.

Ağababaoğlu¹

2019

Acta Medica

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Objective: Blunt thoracic traumas are often complicated with rib fractures. The decision-making process of the treatment approaches not clear for clinicians. So, we aim to investigate the effect of surgical intervention on pain managment of patients as treatment indication. Methods: Cases with 3 or more rib fractures were evaluated in our study. 84 patients underwent open reduction from 2014 to 2018 and 127 patients were treated conservatively from 2014 to 2018 included in the study. Surgery was performed for all cases in first 24-36 hours and no patient needed intensive care. The results of hospitalization time, pneumonia, rates, thoracic deformity rates on 6.month thorax computerized tomography, intercostal blockage requirement, postoperative 6.month quality of life questionnaire for pain and clinical outputs of two groups were retrospectively analyzed. Results: The average hospitalization was found that it was significantly different in favor of the surgical group (z = 6.674; p <0.001). Thoracic deformity rates, intercostal blockage requirement was found to be different between the surgery and non-surgery groups (χ2=7.149;p<0.001), (χ2=22.462;p<0.001). Pain and quality of life scores had also significant difference in favor of the surgical group, respectively (z = 9.270; p <0.001) and (z = 8.796; p <0.001). Additionally there was statistical difference in pneumonia rates (p= 0.020). We did not reach a statistically significant result between the early and late groups in pain 1 and pain 2 results (p1: 0.727, p2: 0.069). Conclusions: There is no consensus on rib fractures. The results of our study suggest that open rib reduction and fixation can be better treatment option than conservative approach in terms of pneumonia rates, hospitalization time, thoracic deformity rates and pain management.

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Effectiveness of intercostal nerve block for management of pain in rib fracture patients

Cited by 40 publications

References 8 publications

When will pulmonary function recover after rib fracture?

When will pulmonary function recover after rib fracture?

Clinical Analysis of the Correlation Between Rib Fractures and Prognosis in Multiple Trauma Patients

Pain Managment of Multiple Rib Fractures on the Basis of Early Reduction and Fixation in Patients without Intensive Care Unit.

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