Acute pain management of patients with multiple fractured ribs

Ho, Anthony M.‐H.; Karmakar, Manoj K.; Critchley, Lester A. H.

doi:10.1097/mcc.0b013e328348bf6f

Cited by 121 publications

(93 citation statements)

References 19 publications

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“…However, many authors have reported that the efficacy of opioids in relieving pain is changeable because of respiratory depression risk and the difficulty of dose adjustment (1-4). Nevertheless, it is reported that the effective pain management can be performed when systemic opioids and locoregional nerve blockage methods are combined together (3,4). In our study, we determined the fractured ribs' levels and performed intercostal nerve blockage before opioid treatment.…”

Section: Discussionmentioning

confidence: 95%

“…Intercostal nerve blockage provides highly effective analgesia lasting for 8-24 hours (3, 4); it can be administered to all fractured ribs except the first ribs. However, the requirement of multiple injections causes discomfort for the patients (3,4). In our study, ICB was performed to the patients immediately after the diagnosis in the emergency service.…”

Section: Discussionmentioning

confidence: 99%

“…In the management of pain due to multiple rib fractures, intercostal blockage and the administration of opioids are among the most frequently applied procedures (4,8). The most common way in which the opioids are used is the parenteral method.…”

Section: Discussionmentioning

confidence: 99%

“…The PCA device is one of the most frequently applied procedures that is able to provide these effects. By PCA device, it is possible to administer opioids safely in minimal doses and via continuous or intermittent intravenous mechanisms (1,3,4). PCA using opioids is one of the most common methods of providing postoperative analgesia for the treatment of acute pain (9, 10).…”

Section: Discussionmentioning

confidence: 99%

“…In the management of pain due to multiple rib fractures, intercostal blockage and parenteral administration of systemic opioids are among the most commonly applied procedures (4). The opioids used for this purpose can be administered in many different ways and dose intervals (3).…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Transdermal Opioid in the Management Multiple Rib Fractures: Randomized Clinical Trial

Öz¹,

Kokulu²,

Solak³

et al. 2013

Balkan Med J

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Background: The most commonly observed pathology in chest traumas is rib fracture, and the most important clinical symptom is severe pain.Aims: To investigate the effectiveness of intramuscular opioid (IMO), intravenous patient-controlled analgesia (IVPCA) and the Fentanyl transdermal therapeutic system (TTS) in the management of rib fracture pain.Study Design: Prospective randomized clinical trial. Methods:In our prospective and randomised study, we included 45 patients with a diagnosis of multiple rib fractures. There were three groups and intercostal nerve blockage (ICB) in the first day and oral paracetamol for five days was administered to each group as standard. In Group IMO (n=15), 4x40 mg pethidine HCl was administered to the patients, while in Group IVPCA (n=15) this was 5 µg/mL continuous intravenous fentanyl and was 50 µg fentanyl TTS in Group TTS (n=15). The demographics, injury data and vital signs of the patients were recorded. Pain was scored using Visual Analogue Scale (VAS). The pain during lying down (VAS l ) and mobilisation (VAS m ) was detected.Results: There were no differences between the three groups regarding age, sex, the trauma pattern, the number and distribution of costal fracture localisations, the presence of additional pathology, complications, thoracal catheter and the duration of thoracal catheter. No significant difference between the groups regarding systolic and diastolic arterial tension, number of breaths and beats in a minute was observed (p>0.05). We observed an improvement in the mean VAS score after treatment in all three groups. The mean VASl score significantly decreased after treatment in each group th and 5 th days were found to be higher in Group IMO than in Groups IVPCA and TTS; however, these differences were not statistically significant (p>0.05). Conclusion:In the analgesia of patients with multiple rib fractures, TTS administration with ICB showed similar effectiveness with IVPCA administration with ICB. In the management of pain due to multiple rib fractures, TTS administration is a safe, non-invasive and effective procedure.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Effectiveness of Transdermal Opioid in the Management Multiple Rib Fractures: Randomized Clinical Trial

Öz¹,

Kokulu²,

Solak³

et al. 2013

Balkan Med J

View full text Add to dashboard Cite

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Using a Simulated Model and Mastery Learning Approach to Teach the Ultrasound‐guided Serratus Anterior Plane Block to Emergency Medicine Residents: A Pilot Study

Rider

Miller

Ashenburg

et al. 2020

AEM Education and Training

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Background:The serratus anterior plane block (SAPB) is a safe, single-injection alternative for pain control in patients with rib fractures. This pilot study aims to teach the ultrasound-guided SAPB to emergency medicine (EM) residents using a mastery learning approach.Methods: A 19-item checklist was created and mastery was determined to be 17 of 19 items correct. This pass score was established using a Mastery Angoff standard-setting exercise with a group of EM experts. Learners participated in baseline testing on a simulated model and performance was assessed by two raters. Learners then watched an instructional video and participated in an individualized teaching session. Learners underwent deliberate practice followed by posttesting until mastery was achieved. Score differences in baseline testing and posttesting were analyzed using a paired t-test. Pre-and posttesting surveys were also completed by participants.Results: Twenty-eight PGY-1 to -4 residents volunteered to participate in the study. The range of reported SAPBs seen previously was 0 to 5. The mean (AESD) number of items correct on the checklist for initial testing was 8.5 of 19 (AE2.7), while the mean (AESD) final score was 18 of 19 (AE0.6; p < 0.001). All participants met mastery standards after the curriculum intervention. Median self-reported procedural confidence was 2 out of 5 on a 5-point Likert scale before the session and 5 out of 5 after the session (Z = À4.681, p < 0.001).Conclusions: Using a mastery learning approach and simulated model, we were able to successfully train EM residents to perform the SAPB at a level of mastery and increase their overall confidence in executing this procedure.

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Erector spinae plane block for multiple rib fracture done by an Emergency Physician: A case series

Gaurav

Bhoi

Sinha

et al. 2020

Australas J Ultrason Med

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The erector spinae plane block is a novel ultrasound‐guided technique that has recently been described for the management of rib fracture pain in the emergency department. This block has been used in the post‐operative period and chronic thoracic pain and is usually done by experts of anaesthesia or critical care. Erector spinae plane block is an unexplored domain for rib fracture pain management in emergency department. We highlight the use of this block is a safe and effective block that can be performed by emergency physician in the emergency department settings with point of care ultrasound.

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Acute pain management of patients with multiple fractured ribs

Abstract: Thoracic epidural, thoracic paravertebral, and intercostal blocks are the top choices for patients with MFR and they are of equivalent efficacy. Each has unique advantages and disadvantages. Our preference tends to be the thoracic paravertebral approach.

Cited by 121 publications

References 19 publications

The Effectiveness of Transdermal Opioid in the Management Multiple Rib Fractures: Randomized Clinical Trial

The Effectiveness of Transdermal Opioid in the Management Multiple Rib Fractures: Randomized Clinical Trial

Using a Simulated Model and Mastery Learning Approach to Teach the Ultrasound‐guided Serratus Anterior Plane Block to Emergency Medicine Residents: A Pilot Study

Erector spinae plane block for multiple rib fracture done by an Emergency Physician: A case series

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