Alternative method of intercostal blockade. A preliminary study of the use of an injector gun for intercostal nerve blockade

Effect of Intercostal Nerve Block with 0.5% Bupivacaine on Peak Expiratory Flow Rate and Arterial Oxygen Saturation in Rib Fractures

BACKGROUND

This prospective study was undertaken to evaluate the efficiency of intercostal nerve block (ICNB) with 0.5% bupivacaine (Marcaine) for pain relief in patients with rib fractures and to correlate the degree of pain relief with changes in the peak expiratory flow rate (PEFR) and oxygen saturation (Sao2).

METHODS

Twenty-one consecutive adult patients admitted with rib fractures associated with severe pain formed the basis of the study. Chest pain was scored on a four-point scale before ICNB, 1 hour after ICNB, and 24 hours after ICNB. Sao2 was measured before and immediately after ICNB. PEFR was measured before and immediately after ICNB.

RESULTS

Pain score and PEFR before and after ICNB showed statistically significant differences (p = 0.0000, df = 20). There was a significant difference between Sao2 before and after ICNB.

CONCLUSION

Significant increases in Sao2 and PEFR occur after ICNB with 0.5% bupivacaine, which also provides sustained analgesia, leading to improvement in respiratory mechanics.

Acute pain management of patients with multiple fractured ribs

BACKGROUND

Multiple rib fracture causes severe pain that can seriously compromise respiratory mechanics and exacerbate underlying lung injury and pre-existing respiratory disease, predisposing to respiratory failure. The cornerstone of management is early institution of effective pain relief, the subject of this review.

METHODS

A MEDLINE search was conducted for the years 1966 through and up to December 2002 for human studies written in English using the keywords "rib fractures", "analgesia", "blunt chest trauma", "thoracic injury", and "nerve block". The reference list of key articles was also searched for relevant articles. The various analgesic techniques used in patients with multiple fractured ribs were summarized.

RESULTS

Analgesia could be provided using systemic opioids, transcutaneous electrical nerve stimulation or non steroidal anti-inflammatory drugs. Alternatively, regional analgesic techniques such as intercostal nerve block, epidural analgesia, intrathecal opioids, interpleural analgesia and thoracic paravertebral block have been used effectively. Although invasive, in general, regional blocks tend to be more effective than systemic opioids, and produce less systemic side effects.

CONCLUSION

Based on current evidence it is difficult to recommend a single method that can be safely and effectively used for analgesia in all circumstances in patients with multiple fractured ribs. By understanding the strengths and weaknesses of each analgesic technique, the clinician can weigh the risks and benefits and individualize pain management based on the clinical setting and the extent of trauma.

Intercostal nerve block by jet injection

A jet injector was used to perform intercostal nerve block as a method of intra-operative and postoperative pain relief at cholecystectomy, using a concentrated solution of local analgesic. This method was shown to be as successful as the conventional needle technique. The risk of pneumothorax, and the problems of the local analgesic solution used are discussed.

Trigger point injections vs. jet injection in the treatment of myofascial pain

Trigger point injections using dilute solutions of local anesthetic agents have proved effective for many patients with myofascial pain. The treatment itself, however, can produce severe pain and may occasionally be associated with complications. It was determined in this study that a local anesthetic solution administered by jet injection in the area of myofascial trigger points was capable of providing short-term pain relief equal to conventional trigger point injections using a hypodermic needle and syringe. The jet injector system produced significantly less pain during treatment than conventional trigger point injections and therefore was preferred by most subjects having the opportunity to compare both forms of treatment.