title: Continuous intercostal nerve blockade for rib fractures: ready for primetime?
abstract: BACKGROUND
  Providing analgesia for patients with rib fractures continues to be a management challenge. The objective of this study was to examine our experience with the use of a continuous intercostal nerve block (CINB). Although this technique is being used, little data have been published documenting its use and efficacy. We hypothesized that a CINB would provide excellent analgesia, improve pulmonary function, and decrease length of stay (LOS).
  
  
  METHODS
  Consecutive adult blunt trauma patients with three or more unilateral rib fractures were prospectively studied over 24 months. The catheters were placed at the bedside in the extrathoracic, paravertebral location, and 0.2% ropivacaine was infused. Respiratory rate, preplacement (PRE) numeric pain scale (NPS) scores, and sustained maximal inspiration (SMI) lung volumes were determined at rest and after coughing. Parameters were repeated 60 minutes after catheter placement (POST). Hospital LOS comparison was made with historical controls using epidural analgesia.
  
  
  RESULTS
  Over the study period, 102 patients met inclusion criteria. Mean age was 69 (21-96) years, mean injury severity score was 14 (9-16), and the mean number of rib fractures was 5.8 (3-10). Mean NPS improved significantly (PRE NPS at rest = 7.5 vs. POST NPS at rest = 2.6, p < 0.05, PRE NPS after cough = 9.4, POST after cough = 3.6, p < 0.05) which was associated with an increase in the SMI (PRE SMI = 0.4 L and POST SMI = 1.3 L, p < 0.05). Respiratory rate decreased significantly (p < 0.05) and only 2 of 102 required mechanical ventilation. Average LOS for the study population was 2.9 days compared with 5.9 days in the historical control. No procedural or drug-related complications occurred.
  
  
  CONCLUSIONS
  Utilization of CINB significantly improved pulmonary function, pain control, and shortens LOS in patients with rib fractures.
authors.affiliation: Methodist Dallas Medical Center, Dallas, Texas, USA. Mike_Truitt@Hotmail.com
authors.forename: Michael S
authors.initials: MS
authors.lastname: Truitt
authors.forename: Jason
authors.initials: J
authors.lastname: Murry
authors.forename: Joseph
authors.initials: J
authors.lastname: Amos
authors.forename: Manuel
authors.initials: M
authors.lastname: Lorenzo
authors.forename: Alicia
authors.initials: A
authors.lastname: Mangram
authors.forename: Ernest
authors.initials: E
authors.lastname: Dunn
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D005260:Female; D005409:Flail Chest / Q000000981:diagnostic imaging / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007367:Intercostal Nerves / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000628:therapy; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D012253:Rib Fractures / Q000000981:diagnostic imaging* / Q000628:therapy*; D000077212:Ropivacaine; D013898:Thoracic Injuries / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014505:Urban Population; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine