Comparing the effectiveness of bupivacaine administration through chest tube and intercostal blockage in patients with rib fractures

Document Type : Original Article

Authors
Mohammad Nasr-Esfahani 1
Mohsen Kolahdouzan 2
Pezhman Pourazari 2
Emad Yazdani 1
1 Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: There are several methods to control pain, especially in traumatic patients with rib fractures. Intrapleural analgesia (IPA) and intercostal block methods are recommended in patients with rib fractures to control pain. Here, we aimed to evaluate and compare the effects of IPA and intercostal block on patients' clinical conditions. Materials and Methods: This is a randomized clinical trial that was performed in 2020–2021 on thirty traumatic patients with rib fractures. We collected the results of arterial blood gas in all patients before interventions including HCO3, pH, pO2, and pCO2 and also evaluated pain of patients. The first group underwent intercostal blockade with standard method with bupivacaine, and for the second group of patients, a chest tube was implanted. Patients were monitored for up to 12 h for pain intensity and need for analgesics. Results: The mean levels of HCO3 decreased in both groups after the interventions, and this decrease was more significant in patients in the intercostal blockade group (P < 0.05). The mean levels of pO2 increased in both groups after interventions, especially in patients in the intercostal blockade group (P < 0.05). The mean pCO2 levels also decreased in both groups (P < 0.05). The mean pain intensity in both groups decreased significantly after the intervention (P < 0.05) and also the mean pain intensity in the intercostal blocking group decreased significantly more than the group treated with chest tube (P < 0.05). Conclusion: Intercostal blockade through bupivacaine is more effective than chest tube administration of bupivacaine in patients with rib fractures.

Keywords

1.
Duggan P. Trauma-tragedy: Symptoms of contemporary performance. Manchester University Press; 2018 Feb 28.  Back to cited text no. 1
    
2.
Callcut RA, Kornblith LZ, Conroy AS, Robles AJ, Meizoso JP, Namias N, et al. The why and how our trauma patients die: A prospective Multicenter Western Trauma Association study. J Trauma Acute Care Surg 2019;86:864-70.  Back to cited text no. 2
    
3.
Zadeh AR, Falahatian M, Alsahebfosoul F. Serum levels of histamine and diamine oxidase in multiple sclerosis. Am J Clin Exp Immunol 2018;7:100.  Back to cited text no. 3
    
4.
Eckert MJ, Martin MJ. Trauma: Spinal cord injury. Surg Clin North Am 2017;97:1031-45.  Back to cited text no. 4
    
5.
Fahim M, Rafiee Zadeh A, Shoureshi P, Ghadimi K, Cheshmavar M, Sheikhinia N, et al. Alcohol and multiple sclerosis: An immune system-based review. Int J Physiol Pathophysiol Pharmacol 2020;12:58-69.  Back to cited text no. 5
    
6.
Velin L, Donatien M, Wladis A, Nkeshimana M, Riviello R, Uwitonze JM, et al. Systematic media review: A novel method to assess mass-trauma epidemiology in absence of databases – A pilot-study in Rwanda. PLoS One 2021;16:e0258446.  Back to cited text no. 6
    
7.
Rashidi B, Payghani C, Khani F, Rafieezadeh A, Alaei H, Reisi P. The effect of levothyroxine on lysolecithin-induced local demyelination in optic chiasm of male rats. J Isfahan Med Sch 2017;35:789-95.  Back to cited text no. 7
    
8.
Hoskin AK, Low R, Sen P, Mishra C, Kamalden TA, Woreta F, et al. Epidemiology and outcomes of open globe injuries: The international globe and adnexal trauma epidemiology study (IGATES). Graefes Arch Clin Exp Ophthalmol 2021;259:3485-99.  Back to cited text no. 8
    
9.
Payghani C, Khani F, Rafieezadeh A, Reisi P, Alaei H, Rashidi B. Effects of levothyroxine on visual evoked potential impairment following local injections of lysolecithin into the rat optic chiasm. Int J Prev Med 2018;9:18.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Shekarchizadeh A, Mohammadi-Moghadam A, Rezvani M, Rahmani P, Eshraghi N, Ghadimi K. Outcome of patients with lumbar spinal canal stenosis due to discogenic under percutaneous laser disc decompression. Am J Neurodegener Dis 2020;9:1-7.  Back to cited text no. 10
    
11.
Babak A, Rouzbahani R, Khalili Nejad R, Rafiee Zadeh A. Comparison of nutritional behaviors and physical activities between overweight/obese and normal-weight adults. Adv Biomed Res 2019;8:62.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Padia SA, Ingraham CR, Moriarty JM, Wilkins LR, Bream PR Jr., Tam AL, et al. Society of interventional radiology position statement on endovascular intervention for trauma. J Vasc Interv Radiol 2020;31:363-9.e2.  Back to cited text no. 12
    
13.
Farrokhi M, Beni AA, Etemadifar M, Rezaei A, Rivard L, Zadeh AR, et al. Effect of fingolimod on platelet count among multiple sclerosis patients. Int J Prev Med 2015;6.  Back to cited text no. 13
    
14.
Castillo RC, Raja SN, Frey KP, Vallier HA, Tornetta P 3rd, Jaeblon T, et al. Improving pain management and long-term outcomes following high-energy orthopaedic trauma (Pain Study). J Orthop Trauma 2017;31 Suppl 1:S71-7.  Back to cited text no. 14
    
15.
Zadeh AR, Farrokhi M, Etemadifar M, Beni AA. Prevalence of benign tumors among patients with multiple sclerosis. American JExperimental Clin Res 2015;2:127-32.  Back to cited text no. 15
    
16.
Gessner DM, Horn JL, Lowenberg DW. Pain management in the orthopaedic trauma patient: Non-opioid solutions. Injury 2020;51 Suppl 2:S28-36.  Back to cited text no. 16
    
17.
Britt T, Sturm R, Ricardi R, Labond V. 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. Local Reg Anesth 2015;8:79-84.  Back to cited text no. 17
    
18.
Peek J, Smeeing DP, Hietbrink F, Houwert RM, Marsman M, de Jong MB. Comparison of analgesic interventions for traumatic rib fractures: A systematic review and meta-analysis. Eur J Trauma Emerg Surg 2019;45:597-622.  Back to cited text no. 18
    
19.
Rafiee Zadeh A, Ghadimi K, Mohammadi B, Hatamian H, Naghibi SN, Danaeiniya A. Effects of estrogen and progesterone on different immune cells related to multiple sclerosis. Caspian J Neurol Sci 2018;4:83-90.  Back to cited text no. 19
    
20.
Agamohammdi D, Montazer M, Hoseini M, Haghdoost M, Farzin H. A comparison of continuous thoracic epidural analgesia with bupivacaine versus bupivacaine and dexmedetomidine for pain control in patients with multiple rib fractures. Anesth Pain Med 2018;8:e60805.  Back to cited text no. 20
    
21.
Hashemzadeh S, Hashemzadeh K, Hosseinzadeh H, Aligholipour Maleki R, Golzari SE. Comparison thoracic epidural and intercostal block to improve ventilation parameters and reduce pain in patients with multiple rib fractures. J Cardiovasc Thorac Res 2011;3:87-91.  Back to cited text no. 21
    
22.
Hofer R, Rosenberg C, Niesen A, Amundson A, Eldrige J. Intercostal nerve blocks using liposomal bupivacaine. Anaesth Cases 2015;3:34-7.  Back to cited text no. 22
    
23.
Demmy TL, Nwogu C, Solan P, Yendamuri S, Wilding G, DeLeon O. Chest tube-delivered bupivacaine improves pain and decreases opioid use after thoracoscopy. Ann Thorac Surg 2009;87:1040-6.  Back to cited text no. 23
    
24.
Caso R, Marshall MB. Liposomal bupivacaine in minimally invasive thoracic surgery: Something is rotten in the state of Denmark. J Thorac Dis 2019;11:S1267-9.  Back to cited text no. 24
    
25.
May L, Hillermann C, Patil S. Rib fracture management. BJA Educ 2016;16:26-32.  Back to cited text no. 25
    
Advanced Biomedical Research
Volume 2022, August
Summer 2022
Pages 1-5