From the Research
The initial treatment for mildly displaced rib fractures should focus on pain management and supportive care, prioritizing oral analgesics, such as acetaminophen and NSAIDs, and regional anesthesia techniques like serratus anterior plane blocks or erector spinae plane blocks, as these approaches have been shown to effectively reduce pain and improve outcomes, as noted in recent studies 1, 2.
Key Components of Treatment
- Oral analgesics: acetaminophen (650-1000mg every 6 hours, not exceeding 4000mg daily) and/or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) for 5-7 days or as needed
- Regional anesthesia techniques: serratus anterior plane blocks or erector spinae plane blocks for more severe pain
- Ice packs: apply to the affected area for 15-20 minutes every 1-2 hours during the first 48 hours to reduce inflammation and pain
- Deep breathing exercises: 10 deep breaths every hour while awake to prevent atelectasis and pneumonia
- Gentle mobility: avoid activities that exacerbate pain but maintain gentle mobility rather than strict bed rest
Rationale
The treatment approach is based on the most recent evidence, which emphasizes the importance of pain management and supportive care in reducing morbidity and mortality associated with rib fractures 3, 4. Regional anesthesia techniques have been shown to be effective in managing pain and improving outcomes, with serratus anterior plane blocks and erector spinae plane blocks being viable alternatives to traditional epidural and paravertebral blocks 1, 2.
Considerations
- Surgical stabilization of rib fractures may be considered in cases of multiple bicortically displaced rib fractures, especially in those with a flail chest and/or a concomitant ipsilateral displaced midshaft clavicular fracture or sternal fracture, as noted in 4.
- The choice of treatment should be individualized based on the patient's specific needs and circumstances, taking into account the potential benefits and risks of each approach, as discussed in 5.