Related Experiment Videos
Interpleural block for patients with multiple rib fractures: comparison with epidural block
K Shinohara1, H Iwama, Y Akama
1Department of Anesthesiology, Fukushima Medical College, Japan.
The Journal of Emergency Medicine
|July 1, 1994
Summary
Interpleural block (IPB) offers comparable pain relief to epidural block (EB) for rib fractures. IPB showed fewer systemic blood pressure changes, making it a potentially safer option for trauma patients.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Trauma Care
Background:
- Unilateral multiple rib fractures and hemopneumothorax present significant pain management challenges.
- Epidural block (EB) is a common regional anesthesia technique, but can have systemic side effects.
- Interpleural block (IPB) is an alternative regional anesthesia technique for thoracic pain.
Purpose of the Study:
- To compare the efficacy and safety of interpleural block (IPB) versus epidural block (EB) for pain management in adults with unilateral multiple rib fractures and hemopneumothorax.
- To evaluate the extent of sensory blockade and systemic effects of both IPB and EB.
- To assess the ease of technique for both IPB and EB.
Main Methods:
- A randomized, crossover, before-after trial involving 17 adult patients with unilateral multiple rib fractures and hemopneumothorax.
- Patients received both IPB and EB on separate hospital days, with 10 ml of 1% lidocaine administered for each block.
- Sensory blockade (thermohypesthesia), pain relief, respiratory parameters (respiratory rate, PaO2), systemic blood pressure, and serum lidocaine levels were monitored.
Main Results:
- Both IPB and EB provided similar pain relief.
- IPB resulted in a shorter, unilateral sensory blockade, while EB produced a wider, bilateral blockade.
- IPB caused minimal changes in systemic blood pressure, whereas EB led to a significant drop, a disadvantage in trauma patients.
- Respiratory rate decreased and PaO2 tended to increase similarly with both techniques.
- Serum lidocaine levels were comparable and within safe limits for both blocks.
- The technique for IPB appeared simpler than for EB.
Conclusions:
- Interpleural block (IPB) is as effective as epidural block (EB) for pain relief in patients with unilateral multiple rib fractures and hemopneumothorax.
- IPB offers a potential safety advantage over EB due to less impact on systemic blood pressure.
- IPB may be a simpler and safer alternative for managing thoracic trauma pain.