Comparison of analgesic effects between ultrasound-guided thoracic paravertebral block and intercostal nerve block in patients with multiple rib fractures

Abstract

Objective To compare the analgesic effects and safety of ultransound-guided thoracic paravertebral block (TPVB) and intercostal nerve block (INB) in patients with unilateral multiple rib fractures. Methods Patients with unilateral multiple rib fractures treated by surgery at the Fifth Affiliated Hospital of Xinjiang Medical University from January 2022 to June 2023 were selected. A total of 82 patients who met the inclusion and exclusion criteria were included,and divided into TPVB group (20 mL of ropivacaine 0.33% for TPVB after general anesthesia) and INB group (5 mL of ropivacaine 0.33% for INB after general anesthesia) by random number table method, with 41 patients in each group. The visual analog score (VAS) was used to assess patients pain, and the time and dosage of analgesics were recorded. The pulmonary and non-pulmonary complications within 72 hours after operation were observed. Results Kaplan-Meier curves showed that there was a statistically significant difference in first use time of analgesics between the two groups (χ2=6.125, P=0.013). The proportion of patients with analgesia demand in the TPVB group was significantly lower than that in the INB group within 24 hours after operation (19.51% vs 36.59%, χ2=4.895， P=0.027)and 48 hours after operation(41.46% vs 63.41%， χ2=3.961， P=0.047), and the total dose of analgesics used 〖LM〗in the TPVB group 25-48 hours after operation was significantly lower than that in the INB group ［(13.78±9.48) mg vs (26.20±12.31)mg, t=3.527, P＜0.01］. VAS scores at rest and during coughing at all time points after surgery significantly decreased in both groups (P＜0.01). At 6 and 18 hours postoperatively, the VAS score at rest in the TPVB group was lower than that in the INB group, and at 1, 6, and 18 hours postoperatively, the VAS score when coughing in the TPVB group was lower than that in the INB group, with statistically significant differences (P＜0.05). There was no statistically significant difference in the incidence of pulmonary and non-pulmonary complications between the two groups (P＞0.05). Conclusion Ultrasound-guided TPVB can effectively alleviate pain and reduce opioid consumption in patients with unilateral multiple rib fractures compared with INB."

Keywords

• multiple rib fracture，analgesia， thoracic paravertebral block， intercostal nerve block， ultrasonic guidance，pulmonary complication