From the Guidelines
The management of closed rib fractures should prioritize pain control, respiratory support, and prevention of complications, with a focus on multimodal analgesia and early mobilization. The cornerstone of treatment is adequate analgesia, which typically includes scheduled acetaminophen (1000 mg every 6 hours) and NSAIDs like ibuprofen (400-600 mg every 6 hours) or naproxen (500 mg twice daily) for mild to moderate pain [ 1 ]. For more severe pain, regional anesthesia techniques like thoracic epidural analgesia or novel myofascial techniques such as erector spinae plane (ESPB) and serratus anterior plane (SAPB) blocks can provide significant relief [ 1 ].
Some key points to consider in the management of closed rib fractures include:
- Deep breathing exercises and incentive spirometry (10 breaths every hour while awake) to prevent atelectasis and pneumonia
- Early mobilization with gradual return to activities as pain allows
- Monitoring for complications such as pneumonia, delayed hemothorax, or pneumothorax, particularly in the first 72 hours
- Consideration of surgical stabilization of rib fractures (SSRF) in patients with flail chest or multiple severely displaced rib fractures [ 1 ]
In terms of specific analgesic options, thoracic epidural analgesia and paravertebral blocks are considered the gold standard for analgesia in rib fractures, offering adequate pain control even in coagulopathic and anticoagulated patients [ 1 ]. Additionally, ketamine has been shown to be a safe and effective alternative to opioids for pain management in rib fractures, with fewer side effects [ 1 ].
Overall, the goal of management is to minimize morbidity, mortality, and improve quality of life for patients with closed rib fractures, and a multimodal approach to pain management and respiratory support is essential to achieving this goal [ 1 ].
From the Research
Management of Closed Rib Fractures
The management of closed rib fractures involves a multidisciplinary approach, with a focus on pain management, respiratory care, and mobilization.
- Pain management is a crucial aspect of care, with the use of multimodal analgesia, including pharmacologic and regional analgesic techniques 2, 3, 4, 5.
- Regional anesthesia techniques, such as thoracic epidural analgesia, 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, 5.
- The choice of analgesic technique depends on the patient's individual case and the team's preferences, with consideration of the potential risks and benefits of each technique 5.
- In addition to pain management, respiratory care is also critical, with a focus on preventing complications such as atelectasis, pneumonia, and respiratory failure 6.
- Rapid mobilization and meticulous respiratory care are also important components of management, with the goal of reducing the length of stay in intensive care units and improving patient outcomes 6.
- Risk stratification is also an important aspect of management, with the use of tools such as the Study of the Management of Blunt Chest Wall Trauma score to identify patients at high risk of complications 2.
- A care bundle or protocol that includes pain management, respiratory care, and mobilization can help to standardize care and improve patient outcomes 6.