Volume-dependent analgesia and dermatomal regression during continuous rhomboid intercostal plane block: lessons from a multiple rib fracture case in intensive care unit

TL;DR

A case study shows how a specific nerve block helped manage pain in a patient with multiple rib fractures, highlighting the need for more research on optimal dosing and techniques.

Contribution

Demonstrates the effectiveness and limitations of Rhomboid Interfascial Plane catheters in managing pain from multiple rib fractures.

Findings

Rhomboid Interfascial Plane catheters provided effective pain relief for a patient with multiple rib fractures.

A reduction in dermatomal spread was observed over 24 hours, suggesting limitations in continuous analgesia.

Abstract

Multiple rib fractures can cause severe respiratory issues if not managed with early and adequate pain control. Without timely and appropriate analgesia, these fractures may lead to significant respiratory complications. Interfascial plane blocks, such as the Rhomboid Interfascial Plane block (RIB), serve as effective adjuncts to pharmacological agents like opioids. However, there is limited literature on the optimal anesthetic volumes and dermatomal spread associated with Rhomboid Interfascial Plane catheters.

A 52-year-old male involved in a motor vehicle accident was diagnosed with non-displaced fractures of ribs 4–9. He was monitored in the intensive care unit, and a Rhomboid Intercostal Plane block was performed at the T6–T7 level using 30 mL of 0.25% bupivacaine. A catheter was then placed at the same level for continuous analgesia.

The Rhomboid Interfascial Plane catheter provided effective pain relief. Over a 24-hour follow-up period, a reduction in dermatomal spread was noted, underscoring the need for further research into optimal dosing and catheter placement techniques for patients with multiple rib fractures.

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