Intercostal nerve block for chest drain insertion
Date First Published:
June 27, 2014
Last Updated:
October 25, 2016
Report by:
Jon Bailey, Academic Clinical Fellow in Emergency Medicine (Thames Valley LETB)
Three-Part Question:
In [patients with acute chest trauma requiring a chest drain] does [intercostal block] provide lower [pain scores]
Clinical Scenario:
A 35 year old patient is hit in the chest with a baseball bat sustaining multiple rib fractures and a haemothorax that requires insertion of a chest drain. You wonder if interpleural block is more effective than standard care at providing analgesia.
Search Strategy:
Medline 1966-09/2016 using the Pubmed interface
Search Details:
(Chest Drain OR Intercostal Drain OR Interpleural Drain) AND (Intercostal block OR Intercostal nerve block OR Interpleural block OR Interpleural nerve block) AND (Pain OR Pain) LIMIT to human AND English language.
Outcome:
11 papers, only one of which was applicable to the three part question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Chest trauma in a developing country. Anyanwu CH, Swarup AS. 1981 Nigeria | 145 patients with chest injuries seen in the Cardiothoracic Surgical Unit of UNTH Enugu between January 1975 and September 1979 (4 years) | Retrospective case series | No discussion of analgesic efficacy |
Author Commentary:
There are no English language papers providing comparison between local and regional analgesia for the insertion of chest drain.
Bottom Line:
This is an evidence free zone.
References:
- Anyanwu CH, Swarup AS.. Chest trauma in a developing country.