The Effectiveness of Intercostal Nerve Block on Return to Work, Quality of Life, and Hand Grip Strength in Patients with Isolated Rib Fractures: a Single-Blind, Randomized Controlled Study

Abstract

Rib fractures are the most common injuries in blunt chest trauma. Rib fractures can cause a lung injury or may occur in the form of an isolated rib fracture. Isolated rib fractures that are broken in single point are usually followed at home with analgesic treatment. In our study, we aimed to investigate the effect of intercostal nerve blockage on pain, quality of life, return to work, and grip strength in patients with isolated single point rib fracture that did not cause lung damage. Between March 2020 and August 2020, a total of 61 patients with the diagnosis of isolated rib fractures were included and divided into two groups. Group 1 (n=29) received one session of intercostal nerve blockage (0.5% bupivacaine 3mL and 5 μg epinephrine) and acetaminophen 500 mg b.i.d. +celecoxib 100 mg b.i.d., while group 2 (n=32) received acetaminophen 500 mg b.i.d. +celecoxib 100 mg b.i.d. Pain severity was evaluated using the Visual Analog Scale quality of life using the Short Form-36, and grip strength using a hand dynamometer at baseline, 1 week, and 1 month. On the second day of evaluation, the patients with Visual Analog Scale score of <3 were allowed to return to work. Of the patients, 44 (72.13%) were men and 17 (27.87%) were women with a mean age of 41.8 SD8.91 (range, 22 to 56) years. There was a statistically significant decrease in the VAS scores in all groups, after treatment compared to baseline, although only the grip strength and Short Form-36 subscale scores were significantly higher (p<0.05). There was also significant difference in the all scale scores in group 1 than group 2. We found significant correlation between the Visual Analog Scale and Short Form-36 subscales after the treatment. These results suggest that oral analgesia with intercostal nerve blockage is more effective than only oral analgesia on pain, quality of life, time to return to work, and grip strength in patients with isolated rib fractures.