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Rhomboid Intercostal Block for Analgesia of Multiple Rib Fractures in an Infant

Basak Altıparmak1, Melike Korkmaz Toker1, Ali Ihsan Uysal1

  • 1Department of Anesthesiology and Reanimation, Mugla Sıtkı Kocman University, Mugla, Turkey.

Turkish Journal of Anaesthesiology and Reanimation
|February 3, 2022
PubMed

Insights

Ultrasound-guided rhomboid intercostal block (RIB) effectively managed pain in an infant with multiple rib fractures and a chest tube. This novel plane block provided significant analgesia, demonstrating its utility in pediatric pain management.

Area of Science:

  • Pediatric Anesthesiology
  • Regional Anesthesia
  • Pain Management

Background:

  • Rhomboid intercostal block (RIB) is a novel fascial plane block.
  • RIB is hypothesized to provide analgesia for both anterior and posterior hemithorax.
  • Limited data exists on RIB in pediatric populations.

Purpose of the Study:

  • To report the successful use of ultrasound-guided RIB in an infant.
  • To evaluate RIB's efficacy for managing pain from multiple rib fractures and chest tube insertion.
  • To assess postoperative pain using the FLACC scale.

Main Methods:

  • Ultrasound-guided rhomboid intercostal block (RIB) performed on a 10-month-old infant.
  • 8 mL of 0.125% bupivacaine administered.
  • Paediatric epidural catheter placed for continuous analgesia.
  • Multimodal analgesia including intravenous paracetamol.

Main Results:

  • Effective analgesia achieved for chest tube insertion and multiple rib fractures (T4-T8).
  • Postoperative pain scores (FLACC scale) remained consistently low (score of 2) at all assessed time points.
  • Successful attenuation of acute postoperative pain.

Conclusions:

  • Ultrasound-guided rhomboid intercostal block (RIB) is a viable and effective technique for pediatric pain management.
  • RIB can provide targeted analgesia for thoracic trauma and procedures in infants.
  • This case highlights the potential of RIB as part of multimodal analgesia in pediatric patients.

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