Continuous intercostal nerve blockade for rib fractures: ready for primetime?

Area of Science:

• Trauma Surgery
• Pain Management
• Anesthesiology

Background:

• Rib fractures present significant analgesia challenges in trauma patients.
• Continuous intercostal nerve block (CINB) is utilized, but efficacy data is limited.
• This study investigates CINB for managing multiple rib fractures.

Purpose of the Study:

• To evaluate the efficacy of continuous intercostal nerve block (CINB) in patients with multiple rib fractures.
• To assess the impact of CINB on pain control, pulmonary function, and length of stay (LOS).
• To compare CINB outcomes with historical epidural analgesia controls.

Main Methods:

• Prospective study of 102 adult blunt trauma patients with ≥3 unilateral rib fractures over 24 months.
• Extrathoracic, paravertebral continuous intercostal nerve block (CINB) with 0.2% ropivacaine.
• Assessed pain (Numeric Pain Scale), pulmonary function (Sustained Maximal Inspiration), and respiratory rate pre- and post-block; compared LOS with historical epidural controls.

Main Results:

• Significant improvement in pain scores (rest and post-cough) and sustained maximal inspiration (SMI) post-CINB.
• Reduced respiratory rate and minimal need for mechanical ventilation (2/102 patients).
• Average LOS was 2.9 days with CINB versus 5.9 days for epidural controls; no complications reported.

Conclusions:

• Continuous intercostal nerve block (CINB) significantly enhances pain management for rib fractures.
• CINB improves pulmonary function and reduces length of stay (LOS) in trauma patients.
• CINB is a safe and effective analgesic technique for managing multiple rib fractures.