From the Guidelines
Pain management for rib fractures should involve a multimodal approach, including the association of systemic analgesic treatment with thoracic epidural and paravertebral blocks to offer adequate pain control with limited contraindications and improvement in respiratory function, reducing opioid consumption, infections, and delirium, if skills are available 1.
Key Considerations
- The use of thoracic epidural analgesia is suggested for patients with traumatic rib fractures, as it provides effective pain control and reduces the need for opioids 1.
- A multimodal approach to pain management, including the use of acetaminophen, NSAIDs, and opioids, as well as regional anesthesia techniques such as thoracic epidural and paravertebral blocks, is recommended for elderly patients with rib fractures 1.
- Novel myofascial techniques, such as erector spinae plane and serratus anterior plane blocks, have been shown to be safe and effective in reducing acute pain in patients with rib fractures 1.
Treatment Options
- Scheduled acetaminophen (1000 mg every 6 hours, not exceeding 4000 mg daily) combined with NSAIDs like ibuprofen (400-600 mg every 6 hours with food) if not contraindicated, for mild to moderate pain.
- Oral opioids such as hydrocodone/acetaminophen (5-10 mg/325 mg every 4-6 hours as needed) for short-term use in more severe pain.
- Thoracic epidural and paravertebral blocks for adequate pain control with limited contraindications and improvement in respiratory function.
- Novel myofascial techniques, such as erector spinae plane and serratus anterior plane blocks, as part of a multimodal approach to pain management.
Important Considerations
- Proper breathing is crucial despite the pain; use a pillow pressed against the chest when coughing or deep breathing to stabilize the area.
- Sleep in a semi-upright position with pillows for support to minimize discomfort.
- Avoid activities that exacerbate pain but maintain gentle movement as tolerated.
- Most rib fractures heal within 6-8 weeks, with pain gradually improving after the first 1-2 weeks.
From the FDA Drug Label
Oxycodone hydrochloride tablets are an opioid agonist indicated for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate The options for managing pain associated with rib fractures include:
- Opioid analgesics like oxycodone, for patients who have not been able to tolerate or receive adequate analgesia from alternative treatments
- Non-opioid analgesics
- Non-opioid combination products These options should be considered based on the patient's specific needs and medical history, with opioid analgesics like oxycodone being reserved for patients who require them due to inadequate alternative treatment options 2
From the Research
Options for Managing Pain Associated with Rib Fractures
The following options are available for managing pain associated with rib fractures:
- Systemic opioids and non-opioid analgesics 3
- Regional anesthesia techniques, including:
- Multimodal analgesia, including the use of intravenous acetaminophen and morphine sulfate 7
- Ultrasound-guided myofascial plane blocks, such as SAPB and ESPB, which can be used as alternatives to TEA and PVB 4
Considerations for Choosing a Pain Management Technique
The choice of pain management technique may depend on the patient's case and the team's preferences 3. Factors to consider include:
- The patient's medical history and any contraindications to certain techniques 3, 4
- The severity of the patient's pain and the potential for complications 5
- The availability of resources and expertise to perform certain techniques 4
- The potential for opioid-sparing and reduced side effects with certain techniques, such as SAPB 6