Emergencies: Edited by Pierre CarliAcute pain management of patients with multiple fractured ribs a focus on regional techniquesHo, Anthony M.-H.; Karmakar, Manoj K.; Critchley, Lester A.H. Author Information Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, PRC Correspondence to Dr Anthony M.-H. Ho, Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, PRCTel: +852 26321133; fax: +852 26372422; e-mail: [email protected] Current Opinion in Critical Care: August 2011 - Volume 17 - Issue 4 - p 323-327 doi: 10.1097/MCC.0b013e328348bf6f Buy Metrics Abstract Purpose of review Thoracic trauma leading to multiple fractured ribs (MFR) remains very common. Good analgesia may help to improve a patient's respiratory mechanics and to avoid intubation of the trachea for ventilatory support and therefore may dramatically alter the course of recovery. We herein review the analgesia options for patients with MFR. Recent findings For healthy patients with one to two fractured ribs, systemic analgesics may suffice. For more than three to four fractured ribs, studies and experience have reaffirmed the superior analgesia made possible with thoracic epidural, thoracic paravertebral, and intercostal blocks. From experience, interpleural block has significant drawbacks. Catheterization allows the continuation of analgesia for 2 or more days with just one block. Use of the landmark technique is usually satisfactory for accurate block placement but ultrasound and nerve stimulation are showing promise in further improving needle and catheter placement accuracy, especially in the presence of difficult anatomy. Summary Thoracic epidural, thoracic paravertebral, and intercostal blocks are the top choices for patients with MFR and they are of equivalent efficacy. Each has unique advantages and disadvantages. Our preference tends to be the thoracic paravertebral approach. © 2011 Lippincott Williams & Wilkins, Inc.