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Erschienen in:

25.09.2023 | Regenerative Pain Medicine/Interventional Pain Medicine (E Cornett Bradley, Section Editor)

Analgesic Techniques for Rib Fractures—A Comprehensive Review Article

verfasst von: Sarang S. Koushik, Alex Bui, Kateryna Slinchenkova, Areen Badwal, Chang Lee, Bryant O. Noss, Jagun Raghavan, Omar Viswanath, Naum Shaparin

Erschienen in: Current Pain and Headache Reports | Ausgabe 11/2023

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Abstract

Purpose of Review

Rib fractures are a common traumatic injury that has been traditionally treated with systemic opioids and non-opioid analgesics. Due to the adverse effects of opioid analgesics, regional anesthesia techniques have become an increasingly promising alternative. This review article aims to explore the efficacy, safety, and constraints of medical management and regional anesthesia techniques in alleviating pain related to rib fractures.

Recent Findings

Recently, opioid analgesia, thoracic epidural analgesia (TEA), and paravertebral block (PVB) have been favored options in the pain management of rib fractures. TEA has positive analgesic effects, and many studies vouch for its efficacy; however, it is contraindicated for many patients. PVB is a viable alternative to those with contraindications to TEA and exhibits promising outcomes compared to other regional anesthesia techniques; however, a failure rate of up to 10% and adverse complications challenge its administration in trauma settings. Serratus anterior plane blocks (SAPB) and erector spinae blocks (ESPB) serve as practical alternatives to TEA or PVB with lower incidences of adverse effects while exhibiting similar levels of analgesia. ESPB can be performed by trained emergency physicians, making it a feasible procedure to perform that is low-risk and efficient in pain management. Compared to the other techniques, intercostal nerve block (ICNB) had less analgesic impact and required concurrent intravenous medication to achieve comparable outcomes to the other blocks.

Summary

The regional anesthesia techniques showed great success in improving pain scores and expediting recovery in many patients. However, choosing the optimal technique may not be so clear and will depend on the patient’s case and the team’s preferences. The peripheral nerve blocks have impressive potential in the future and may very well surpass neuraxial techniques; however, further research is needed to prove their efficacy and weaknesses.

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Titel: Analgesic Techniques for Rib Fractures—A Comprehensive Review Article
verfasst von: Sarang S. Koushik
Alex Bui
Kateryna Slinchenkova
Areen Badwal
Chang Lee
Bryant O. Noss
Jagun Raghavan
Omar Viswanath
Naum Shaparin
Publikationsdatum: 25.09.2023
Verlag: Springer US
Erschienen in: Current Pain and Headache Reports / Ausgabe 11/2023
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-023-01172-9

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Analgesic Techniques for Rib Fractures—A Comprehensive Review Article