The Treatment of Rib Fractures

2020 ◽  
Vol 86 (9) ◽  
pp. 1144-1147
Author(s):  
Paige Farley ◽  
Parker R. Mullen ◽  
Catherine N. Taylor ◽  
Yannleei L. Lee ◽  
Charles C. Butts ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Injury Severity ◽  
Intercostal Nerve ◽  
Rib Fractures ◽  
Hospital Length Of Stay ◽  
Intercostal Nerve Block ◽  
Nerve Blocks ◽  
Multiple Rib Fractures

Background Rib fractures are a major problem characterized by pain, increased length of stay, and respiratory complications. Treatments include fixation, management with opiates, paraspinous local anesthetic pumps, and intercostal nerve blocks. The aim of this study was to evaluate the use of treatment options and compare clinically relevant outcomes. Methods Patients admitted to a Level 1 trauma center with multiple rib fractures between 2015 and 2019 were screened. We included all participants treated with surgical fixation and/or intercostal nerve block or local anesthetic pump. Patients were case-matched 1:2 by Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) Chest and Head, age, and number of rib fractures. Outcomes assessed were hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, pneumonia, and tracheostomy rates. Results We identified 25 patients who received rib fixation and intercostal analgesia. Of these, 14 cases were treated with liposomal bupivaicaine nerve block and 11 by paraspinous catheter block. Fifty control cases treated with opiates were identified. All patients survived to discharge. Cases and controls were approximately equivalent in age, ISS, number of fractured ribs, chest AIS, and head AIS. Rib-plated patients had a lower rate of pneumonia (OR 0.2029, 95% CI 0.0242, 0.09718), decreased average ICU LOS (10.62 vs 6.64, P = .018), and decreased average ventilator days (5.44 vs 1.68, P = .003). Discussion Findings suggest more aggressive treatment of rib fractures may decrease ICU LOS, ventilator days, and pneumonia in patients with multiple rib fractures. These findings are in line with current literature; however, more research is needed in this area.

scholarly journals Subtotal Spinal Anaesthesia as a Complication of Intrathoracic Intercostal Nerve Blocks

1981 ◽  
Vol 9 (4) ◽  
pp. 387-389 ◽  
Author(s):  
S. C. Chester ◽  
G. A. Gutteridge
Keyword(s):  
Nerve Block ◽  
Spinal Anaesthesia ◽  
Intercostal Nerve ◽  
Intercostal Nerve Block ◽  
Nerve Blocks ◽  
Intraneural Injection

A patient developed subtotal spinal anaesthesia following intercostal nerve block performed by the surgeon during thoracotomy. Direct intraneural injection of bupivacaine appeared to be the most likely mechanism for this complication.

Epidural Block Using Large Volumes of Local Anesthetic Solution for Intercostal Nerve Block

1985 ◽  
Vol 63 (2) ◽  
pp. 214-216 ◽  
Author(s):  
ROBERT E. MIDDAUCH ◽  
EMIL J. MENK ◽  
WILLIAM J. REYNOLDS ◽  
JOHN M. BAUMAN ◽  
MICHAEL A. CAWTHON ◽  
...  
Keyword(s):  
Nerve Block ◽  
Local Anesthetic ◽  
Intercostal Nerve ◽  
Epidural Block ◽  
Intercostal Nerve Block ◽  
Anesthetic Solution ◽  
Local Anesthetic Solution

Effect of Regional Analgesia Techniques on Opioid Consumption and Length of Stay After Thoracic Surgery

2020 ◽  
pp. 108925322094943
Author(s):  
Wills C. Dunham ◽  
Frederick W. Lombard ◽  
David A. Edwards ◽  
Yaping Shi ◽  
Matthew S. Shotwell ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Epidural Analgesia ◽  
Thoracic Surgery ◽  
Multimodal Analgesia ◽  
Intercostal Nerve ◽  
Opioid Consumption ◽  
Hospital Length Of Stay ◽  
Intercostal Nerve Block ◽  
Regional Analgesia ◽  
Liposomal Bupivacaine

Background We examined how intercostal nerve block (ICNB) with standard bupivacaine and ICNB with extended-release liposomal bupivacaine, compared with thoracic epidural analgesia (TEA), were associated with postoperative opioid pain medication consumption and hospital length of stay (LOS) after thoracic surgery. Methods We studied 1935 patients who underwent thoracic surgery between January 1, 2010, and November 30, 2017, at a tertiary academic center. Primary and secondary outcomes were postoperative opioid consumption expressed as morphine milligram equivalents (MMEs) at 24, 48, and 72 hours after surgery, the LOS, and total MME consumption from surgery to discharge. Results Of these patients, 888 (45.9%) received TEA, 730 (37.7%) ICNB with standard bupivacaine, 127 (6.6%) ICNB with liposomal bupivacaine, and 190 (9.8%) no regional analgesia. Compared with epidural analgesia, in 2017, ICNB liposomal bupivacaine provided similar pain control in terms of MME consumption at 24 and 72 hours, but decreased MME consumption at 48 hours (odds ratio [OR] = 0.33; confidence interval [CI] = 0.14-0.81) and at discharge (OR = 0.28; CI = 0.12-0.68) and was associated with a higher likelihood for a shorter LOS (hazard ratio = 3.46; CI = 2.42-4.96). Compared with TEA, ICNB with standard bupivacaine and no regional analgesia use showed varying impact on MME consumption between 24 and 72 hours after surgery, and their use was not associated with a significantly reduced MME consumption at discharge but with a shorter hospital LOS. Conclusions Multimodal analgesia involving regional anesthetic alternatives to TEA could help manage postoperative pain in thoracic surgery patients.

Incidence of Pneumothorax from Intercostal Nerve Block for Analgesia in Rib Fractures

2001 ◽  
Vol 51 (3) ◽  
pp. 536-539 ◽  
Author(s):  
Christina M. Shanti ◽  
Arthur M. Carlin ◽  
James G. Tyburski
Keyword(s):  
Nerve Block ◽  
Intercostal Nerve ◽  
Rib Fractures ◽  
Intercostal Nerve Block

scholarly journals Epidemiology of combined clavicle and rib fractures: a systematic review

2021 ◽  
Author(s):  
Arthur A. R. Sweet ◽  
Reinier B. Beks ◽  
Frank F. A. IJpma ◽  
Mirjam B. de Jong ◽  
Frank J. P. Beeres ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Rib Fractures ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Multiple Rib Fractures ◽  
Polytrauma Patients ◽  
Clavicle Fractures

Abstract Purpose The aim of this systematic review was to provide an overview of the incidence of combined clavicle and rib fractures and the association between these two injuries. Methods A systematic literature search was performed in the MEDLINE, EMBASE, and CENTRAL databases on the 14th of August 2020. Outcome measures were incidence, hospital length of stay (HLOS), intensive care unit admission and length of stay (ILOS), duration of mechanical ventilation (DMV), mortality, chest tube duration, Constant–Murley score, union and complications. Results Seven studies with a total of 71,572 patients were included, comprising five studies on epidemiology and two studies on treatment. Among blunt chest trauma patients, 18.6% had concomitant clavicle and rib fractures. The incidence of rib fractures in polytrauma patients with clavicle fractures was 56–60.6% versus 29% in patients without clavicle fractures. Vice versa, 14–18.8% of patients with multiple rib fractures had concomitant clavicle fractures compared to 7.1% in patients without multiple rib fractures. One study reported no complications after fixation of both injuries. Another study on treatment, reported shorter ILOS and less complications among operatively versus conservatively treated patients (5.4 ± 1.5 versus 21 ± 13.6 days). Conclusion Clavicle fractures and rib fractures are closely related in polytrauma patients and almost a fifth of all blunt chest trauma patients sustain both injuries. Definitive conclusions could not be drawn on treatment of the combined injury. Future research should further investigate indications and benefits of operative treatment of this injury.

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