From the Guidelines
Mild displaced rib fractures should be managed conservatively with a focus on pain control and prevention of complications, as surgical intervention is typically not necessary for this type of injury. The primary goal of treatment is to ensure proper breathing and prevent secondary respiratory complications, which can be achieved through adequate pain management and breathing exercises 1.
Pain Management
Pain control is crucial in the management of mild displaced rib fractures. The treatment should start with acetaminophen (Tylenol) 650-1000mg every 6 hours as needed, combined with NSAIDs like ibuprofen 400-600mg every 6-8 hours with food if not contraindicated 1. For more severe pain, the doctor may prescribe opioids such as hydrocodone/acetaminophen (Norco) for short-term use. However, recent studies suggest that ketamine can be a safe and effective alternative to opioids for pain management in rib fractures, with fewer side effects 1.
Breathing Exercises and Physical Activity
Breathing exercises are essential to prevent pneumonia; patients should take 10 deep breaths every hour while awake, holding each for 3-5 seconds 1. Rest and limited activity for 1-2 weeks are recommended, gradually increasing movement as pain allows. Ice the affected area for 20 minutes every 2-3 hours during the first 48-72 hours to reduce inflammation. Splinting the area by hugging a pillow when coughing or sneezing can reduce pain.
Monitoring and Follow-up
Most mild displaced rib fractures heal within 6-8 weeks without surgical intervention 1. Patients should seek immediate medical attention if they experience increasing pain, difficulty breathing, fever, or coughing up blood, as these may indicate complications like pneumonia or punctured lung. The conservative approach works because ribs typically heal well on their own, and pain management allows for proper breathing, which prevents secondary respiratory complications 1.
Recent Advances in Pain Management
Recent studies have shown that novel myofascial techniques such as erector spinae plane (ESPB) and serratus anterior plane (SAPB) blocks can be effective in reducing acute pain in patients with rib fractures 1. These techniques can be considered as part of a multimodal analgesia approach, especially in older patients or those with contraindications to traditional pain management options.
From the Research
Management of Mild Displaced Rib Fractures
- The management of mild displaced rib fractures primarily focuses on pain control and prevention of complications such as respiratory issues 2, 3, 4, 5, 6.
- A multimodal analgesia approach is recommended, which may include pharmacologic and regional analgesic blocks 2, 3, 4.
- Regional anesthesia techniques such as thoracic epidural analgesia, thoracic paravertebral block, erector spinae plane block, and serratus anterior plane block have been shown to be effective in managing pain associated with rib fractures 3, 4.
- The choice of analgesic technique depends on the patient's case and the team's preferences, with consideration of the potential risks and benefits of each technique 3, 4.
- Myofascial plane blocks, such as the erector spinae plane block and the serratus anterior plane block, have emerged as alternatives to traditional epidural and paravertebral approaches, offering excellent analgesia with minimal side effects 4.
Pain Management Strategies
- Pharmacologic options for pain management include acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, lidocaine, and dexmedetomidine 2.
- Regional analgesia techniques, such as intercostal nerve blocks and paraspinous local anesthetic pumps, may also be used to manage pain associated with rib fractures 5.
- Surgical fixation of rib fractures may be considered in certain cases, and has been shown to decrease the rate of pneumonia, intensive care unit length of stay, and ventilator days 5.
Clinical Considerations
- Risk stratification is an important aspect of managing patients with rib fractures, with the goal of identifying those at high risk of complications and providing prompt and effective analgesia 2.
- The development of chronic pain and disabilities is a significant concern in patients with rib fractures, highlighting the need for effective pain management and rehabilitation strategies 2, 6.
- A multidisciplinary approach to management, combined with appropriate analgesia and adherence to care bundles/protocols, has been shown to decrease morbidity and mortality in patients with rib fractures 2.