From the Guidelines
Yes, intercostal nerve blocks can be performed in patients with rib fractures and are often recommended for pain management in these cases. The procedure involves injecting local anesthetics such as ropivacaine near the intercostal nerves, as studied by Zhang et al. 1 and Maher et al. 1, who reported significantly lower pain scores and reduced opioid requirements. Blocks should be performed at the fracture level and 1-2 levels above and below for optimal pain relief.
- The anesthetic effect typically lasts several hours, though adding perineural dexamethasone or dexmedetomidine can prolong the duration of analgesia, as seen in the study by Zhang et al. 1.
- Potential complications including pneumothorax, vascular puncture, local anesthetic systemic toxicity, and infection should be considered, and the use of ultrasound guidance can improve safety by allowing direct visualization of anatomical structures during the procedure.
- The benefits of intercostal nerve blocks in patients with rib fractures include improved breathing mechanics, better cough effectiveness, and reduced opioid requirements, as reported by Ahmed et al. 1.
- The optimal local anesthetic mixture for intercostal nerve blocks in patients with rib fractures may include ropivacaine plus perineural dexamethasone or dexmedetomidine, as studied by Zhang et al. 1 and Maher et al. 1.
From the Research
Intercostal Nerve Block with Rib Fractures
- Intercostal nerve blocks can be performed in patients with rib fractures, as evidenced by several studies 2, 3, 4, 5, 6.
- These blocks provide adequate anesthesia and can be performed in an emergency department setting, reducing the need for opioids or other delirium-inducing medications 2.
- The use of continuous intercostal nerve blockade has been associated with improved outcomes in patients with multiple rib fractures, including reduced hospital mortality, pneumonia, and need for tracheostomy 3.
- Intercostal nerve blocks with liposomal bupivacaine have been shown to be effective in reducing pain and improving outcomes in patients with traumatic rib fractures, with fewer complications compared to epidural analgesia 4.
- Continuous intercostal nerve blocks have also been found to improve pulmonary function, reduce pain, and shorten hospital length of stay in patients with rib fractures 5.
- While intercostal nerve blocks can provide effective pain control, their efficacy may decrease over time, and additional pain control methods may be necessary 6.
Key Findings
- Intercostal nerve blocks are a viable option for managing pain in patients with rib fractures 2, 3, 4, 5, 6.
- These blocks can be performed safely and effectively in an emergency department setting 2.
- The use of continuous intercostal nerve blockade can improve outcomes in patients with multiple rib fractures 3.
- Intercostal nerve blocks with liposomal bupivacaine may be a superior alternative to epidural analgesia for managing pain in patients with traumatic rib fractures 4.