Rib fracture management

May, L.; Hillermann, C.; Patil, Sunil

doi:10.1093/bjaceaccp/mkv011

Cited by 85 publications

(109 citation statements)

References 16 publications

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“…Management of these patients is mainly dependent on urgent and adequate pain control to help them breathe and cough effectively and cooperate for chest physiotherapy in order to maintain normal ventilation [16][17][18]. Dexmedetomidine has analgesic effect mediated through its action at the level of brain and brain stem, spinal cord and also at peripheral tissues [19] which is not dose-dependent; however, its hemodynamic associated effects are dependent on its dose [20,21].…”

Section: Discussionmentioning

confidence: 99%

Intravenous versus Ultrasound Guided Thoracic Paravertebral Morphine-Dexmedetomidine Combination in Patients with Multiple Rib Fractures

Mogahed¹,

Salama²,

Elkahwagy³

2017

J Anesth Clin Res

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Section: Discussionmentioning

confidence: 99%

Intravenous versus Ultrasound Guided Thoracic Paravertebral Morphine-Dexmedetomidine Combination in Patients with Multiple Rib Fractures

Mogahed¹,

Salama²,

Elkahwagy³

2017

J Anesth Clin Res

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“…Analgesia is one of the cornerstones for ventilatory mechanics through respiratory rehabilitation: active mobilization, cough assistance, and intensive respiratory physiotherapy . In case of failure of systemic analgesia, locoregional analgesia (LRA) is recommended …”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7] Analgesia is one of the cornerstones for ventilatory mechanics through respiratory rehabilitation: active mobilization, cough assistance, and intensive respiratory physiotherapy. [8][9][10] In case of failure of systemic analgesia, locoregional analgesia (LRA) is recommended. 8,11 Currently, regional analgesia reference techniques are epidural analgesia, intercostal nerve block, and paravertebral block (PVB).…”

Section: Introductionmentioning

confidence: 99%

Serratus Plane Block Is Effective for Pain Control in Patients With Blunt Chest Trauma: A Case Series

et al. 2019

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Background Rib fractures occur frequently following blunt chest trauma and induce morbidity and mortality. Analgesia is a cornerstone for their management, and regional analgesia is one of the tools available to reach this objective. Epidural and paravertebral blocks are the classical techniques used, but the serratus plane block (SPB) has recently been described as an effective technique for thoracic analgesia. Methods This case series reported and analyzed 10 consecutive cases of SPB for blunt chest trauma analgesia in a level 1 trauma center from May to October 2018. SPB was performed with either a single shot of local anesthetic or a catheter infusion. Results Ten patients were treated with 3 single shots and 7 catheter infusions (median length 3 days [interquartile range (IQR) 2.5 to 3.5]). The Median Injury Severity Score was 16 (IQR 16 to 23), and the number of broken ribs ranged from 3 to 22. Daily equivalent oral morphine consumption was significantly decreased after SPB from 108 mg (IQR 67 to 120) to 19 mg (IQR 0 to 58) (P = 0.015). The Numeric Pain Rating Scale (NPRS) score during cough was significantly decreased from 7.3 (IQR 5.3 to 8.8) to 4 (IQR 3.6 to 4.6) (P = 0.03). The NPRS score at rest remained unchanged. One complication occurred, due to a catheter section. Conclusions The SPB technique (with or without catheter insertion) in 10 patients who had blunt chest trauma with rib fractures is effective for cough pain control, with a significant decrease in morphine consumption.

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“…An injury severe enough to fracture ribs will invariably cause a substantial contusion to the underlying lung. The damaged lung is poorly compliant and will not take part in gas exchange [8]. Pulmonary contusion usually resolves without causing permanent complications [9].…”

Section: Introductionmentioning

confidence: 99%

Prognosis of Pulmonary Function in Patients with Multiple Rib Fractures

Park

Hyun

Kim

et al. 2017

Journal of Trauma and Injury

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Purpose: Rib fracture is the most common complication of blunt thoracic trauma. We investigated the effect of rib fracture on pulmonary function in the conservatively treated patients. Methods: From January 2000 to February 2017, we reviewed the records of 72 patients with rib fracture and pulmonary function tests were performed. According to the number of rib fractures, patients were classified into two groups: less than six fractured ribs (group A) and more than six fractured ribs (group B). The groups were compared concerning demographics, underlying diseases, associated thoracic injuries, surgery, mechanical ventilator times, days spent in the intensive care unit and pulmonary function test. Results: There were no statistically significant differences in the demographic data between the two groups. Mean hospitalization was 13.5 days in group A and 27.0 days in group B (p<0.001). There was no statistically significant difference between the two groups in the pulmonary function test. Conclusions: We conclude that pulmonary function is restored by conservative treatment in patients with rib fractures even if the number of rib fractures increases. In patients with multiple rib fractures, studies comparing open rib fixation and conservative treatment of long term pulmonary function are required.

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Rib fracture management

Abstract: Traumatic rib fractures are common, resulting from significant forces impacting on the chest, and are associated with significant morbidity and mortality.• Respiratory complications, including pneumonia, are common occurring in up to 31% of patients.

Cited by 85 publications

References 16 publications

Intravenous versus Ultrasound Guided Thoracic Paravertebral Morphine-Dexmedetomidine Combination in Patients with Multiple Rib Fractures

Intravenous versus Ultrasound Guided Thoracic Paravertebral Morphine-Dexmedetomidine Combination in Patients with Multiple Rib Fractures

Serratus Plane Block Is Effective for Pain Control in Patients With Blunt Chest Trauma: A Case Series

Prognosis of Pulmonary Function in Patients with Multiple Rib Fractures

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