Coccoluto Nicholas, Penhallurick Chase, Ramanujam Vendhan
Anesthesiology, Rhode Island Hospital, Brown University, Providence, USA.
Cureus. 2024 Dec 22;16(12):e76187. doi: 10.7759/cureus.76187. eCollection 2024 Dec.
Acute pain service was consulted for acute pain management in a 40-year-old male who had sustained multiple bilateral rib fractures following a fall injury. In addition to the rib fractures, the patient had also experienced injuries to his lungs and spinal column, both of which required surgeries. Considering the significant nature of pain due to his rib fractures, a multimodal pain management approach that included both pharmacological and non-pharmacological strategies was utilized. A thoracic epidural was performed by the acute pain service to provide immediate onset analgesia, especially during his stay in the hospital. At the same time, the surgeon performed thoracic intercostal nerve cryoablation, where nerves are frozen to prevent them from sending pain signals to the brain to provide analgesia for the patient even after getting discharged from the hospital. Both were done during a perioperative period. The cryoablations complemented the epidural, and they ensured continuous pain control in this patient. This report is unique as literature on utilizing both thoracic epidural and intercostal nerve ablations as part of a multimodal pain management approach for rib fractures is sparse.
一名40岁男性因跌倒受伤导致双侧多发肋骨骨折，为此咨询了急性疼痛服务团队以进行急性疼痛管理。除肋骨骨折外，该患者肺部和脊柱也受到损伤，二者均需手术治疗。鉴于其肋骨骨折所致疼痛的严重性，采用了包括药物和非药物策略在内的多模式疼痛管理方法。急性疼痛服务团队实施了胸椎硬膜外麻醉以提供即时镇痛，尤其是在他住院期间。与此同时，外科医生进行了胸段肋间神经冷冻消融术，即通过冷冻神经来阻止其向大脑发送疼痛信号，从而为患者出院后也提供镇痛效果。这两项操作均在围手术期进行。冷冻消融术与硬膜外麻醉相辅相成，确保了该患者的持续疼痛控制。本报告具有独特性，因为将胸椎硬膜外麻醉和肋间神经消融术作为肋骨骨折多模式疼痛管理方法一部分的文献较为稀少。
