Artono Isharanto,

SpB, SpBTKV
Division of Thoracic, Cardiac and
Vascular Surgery
Rib Fracture
Saiful
Anwar Hospital

Most common thoracic injury

Increase morbidity and mortality
Pulmonary function is compromised
Acute pain control is critical

Principles
1.
Inadequate pain control
a.
Inability to cough and breath deeply
b.
Sputum retention
c.
Atelectasis
d.
Reduction in FRC
e.
Compromised lung compliance
f.
Ventilation-perfusion mismatch
g.
Hypoxemia
h.
Respiratory failure
2.
Resuscitation precedes pain relief
3.
Multimodal analgesia is recommended
Options
1)
Medication

Oral

IV
2)
Regional analgesia

Topical

Intercostal nerve block

Intrapleural
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Paravertebral block

Epidural
Surgical Fixation

3)
First

Aid
Analgesia
Deep breathing and coughing
Avoid taping / bandaging / splinting

Medication
a) Acetaminophen
b) NSAID Ketorolac, ibuprofen, voltaren, tramadol
c) Opioids Morphine, fentanyl, codeine, PCA
d) Gabapentin
e) Tricyclics
IV Narcotics

Advantages
Rapid onset
Less painful than IM & SC

Disadvantages
Respiratory depression
RN certification
Must wean
Peaks and troughs
PCA

Advantages
Better than IV bolus
Continuous baseline
Patient controlled
Disadvantages
Patient must comprehend
Machine errors
Family interference
Weaning
Sedation

Lidocaine 5% patch Mechanism

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Penetrates the skin

Binds sodium channels
Block influx sodium
Reduce abnormal ectopic discharges produced by
damaged nerves

Surgical Fixation
> 4 segment flail
Intubated
Stove in chest
Thoracotomy for other indications
Dont:

Severe head injury

Other life threatening injuries

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Take Home

Pain control

Pain control

Pain control

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