Chung Y T, Sun W Z, Huang F Y, Cheung Y F
Department of Anesthesiology, Provincial Taipei Hospital, R.O.C.
Ma Zui Xue Za Zhi. 1990 Dec;28(4):419-24.
Multiple rib fractures result in agonizing pain as well as impaired pulmonary functions. Mechanical ventilations are frequently indicated for those with poor respiratory reserves. Regional anesthesia has been advocated for easing pain and discomfort. We evaluate the efficacy of subpleural block in the treatment of multiple rib fractures. Ten patients who sustained multiple rib fractures were observed on the arrival of emergent service. One sustained flailed chest with respiratory distress which necessitated mechanical ventilation in intensive care unit. Subpleural block with 20 ml 0.5% bupivacaine was done to each patient. The location of catheter was identified by the injection of contrast medium. Serial visual analogue pain scale, arterial blood gas, and pulmonary function test were taken before and after subpleural block. Pulmonary function test significantly improved after subpleural block. Pain relief was immediate and desirable. The case in ICU weaned from ventilator 3 days later. There were no major complications after subpleural block. Inadvertent epidural spread and recurrent laryngeal nerve blocks were detected both clinically and radiologically without sequela noted. Subpleural block is effective both in pain relief and in improving pulmonary functions. Image intensifier is essential to subpleural block in order to prevent the misplacement of catheter. We recommend subpleural block to be an alternative approach of regional anesthesia in patients with multiple rib fractures.
多根肋骨骨折会导致剧痛以及肺功能受损。对于呼吸储备功能差的患者，常需进行机械通气。区域麻醉一直被提倡用于缓解疼痛和不适。我们评估了胸膜下阻滞在治疗多根肋骨骨折中的疗效。10例多根肋骨骨折患者在急诊就诊时被观察。其中1例出现连枷胸并伴有呼吸窘迫，需要在重症监护病房进行机械通气。对每位患者进行了20毫升0.5%布比卡因的胸膜下阻滞。通过注入造影剂确定导管位置。在胸膜下阻滞前后进行了连续视觉模拟疼痛评分、动脉血气分析和肺功能测试。胸膜下阻滞后肺功能测试有显著改善。疼痛立即得到缓解且效果良好。重症监护病房的该例患者在3天后脱机。胸膜下阻滞后未出现重大并发症。在临床和影像学上均检测到意外的硬膜外扩散和喉返神经阻滞，但未发现后遗症。胸膜下阻滞在缓解疼痛和改善肺功能方面均有效。影像增强器对于胸膜下阻滞至关重要，以防止导管误置。我们推荐胸膜下阻滞作为多根肋骨骨折患者区域麻醉的一种替代方法。
