Comparative evaluation of continuous intercostal nerve block or epidural analgesia on the rate of respiratory complications, intensive care unit, and hospital stay following traumatic rib fractures: a retrospective review

Abstract

BackgroundThoracic trauma accounts for 10%–15% of all trauma admissions. Rib fractures are the most common injury following blunt thoracic trauma. Epidural analgesia improves patient outcomes but is not without problems. The use of continuous intercostal nerve blockade (CINB) may offer superior pain control with fewer side effects. This study’s objective was to compare the rate of pulmonary complications when traumatic rib fractures were treated with CINB vs epidurals.MethodsA hospital trauma registry provided retrospective data from 2008 to 2013 for patients with 2 or more traumatic rib fractures. All subjects were admitted and were treated with either an epidural or a subcutaneously placed catheter for continuous intercostal nerve blockade. Our primary outcome was a composite of either pneumonia or respiratory failure. Secondary outcomes included total hospital days, total ICU days, and days on the ventilator.Results12.5% (N=8) of the CINB group developed pneumonia or had respiratory failure compared to 16.3% (N=7) in the epidural group. No statistical difference (P=0.58) in the incidence of pneumonia or vent dependent respiratory failure was observed. There was a significant reduction (P=0.05) in hospital days from 9.72 (SD 9.98) in the epidural compared to 6.98 (SD 4.67) in the CINB group. The rest of our secondary outcomes showed no significant difference.ConclusionThis study did not show a difference in the rate of pneumonia or ventilator-dependent respiratory failure in the CINB vs epidural groups. It was not sufficiently powered. Our data supports a reduction in hospital days when CINB is used vs epidural. CINB may have advantages over epidurals such as fewer complications, fewer contraindications, and a shorter time to placement. Further studies are needed to confirm these statements.

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

“…Paravertebral blocks have been associated with fewer AEs such as hypotension and respiratory depression than epidurals (Chelly, 2012). Intercostal blocks also have effectively relieved pain after rib fracture (De Cosmo, Aceto, Gualtieri, & Congedo, 2009), and continuous infusion intercostal blocks have been shown to reduce hospitalization time versus continuous epidural infusion (Britt, Sturm, Ricardi, & Labond, 2015). …”

Reaching is Better When You Get What You Want: Realtime Feedback of Intended Reaching Trajectory Despite an Unstable Environment

“…It is important to distinguish the signal we are exploring from others that may use the word “intent.” One source of complexity is that formation of actions is a multi-step process in which several brain regions contribute. The intent we refer to here is not the goal-oriented intent that might temporally precede the computation of the motor plan (Haggard, 2008 ; Mirabella, 2014 ). The intended trajectory and goal remain malleable and can change (or be suppressed) even after execution (Ghez et al, 1997 ).…”

“…Despite our capacity to learn and adapt, some environments evolve too quickly or with too much uncertainty for meaningful learning. Human and animal nervous systems intelligently solve many problems by planning ahead (Belen'kii et al, 1967 ) and suppressing suboptimal actions (Mirabella, 2014 ), yet in the face of uncertainties we often cannot adequately prevent errors. There is the possibility, however, to exploit additional information from instruments—particularly fast and accurate force sensors—that can measure human machine interactions.…”

“…Combining sensors with filtering techniques makes it possible to determine a person's underlying intent , operationally defined as the motion they would have made had they not been disturbed. While other components of a movement, such as its goal, are also intended (Mirabella, 2014 ), our work here addresses only the intended trajectory. This intent provides new ways to understand the nature of control and provide novel feedback.…”

Anesthesia upstream of the alcoholic lesion point alleviates the pain of alcohol neurolysis for intercostal neuralgia: a prospective randomized clinical trial

“…Intractable intercostal neuralgia often manifests as a sharp or burning pain accompanied by exacerbation when coughing and sneezing, and pain to the touch (2), which significantly reduces the quality of life. Many methods have been adopted to treat intractable intercostal neuralgia, including drugs (3), nerve block (4)(5)(6), and pulsed radiofrequency (7). However, the conventional operations were not effective enough, and they often needed repeating and offered short-term therapeutic effects.…”