Effect of Intercostal Nerve Block with 0.5% Bupivacaine on Peak Expiratory Flow Rate and Arterial Oxygen Saturation in Rib Fractures

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Abstract
Background This prospective study was undertaken to evaluate the efficiency of intercostal nerve block (ICNB) with 0.5% bupivacaine (Marcaine) for pain relief in patients with rib fractures and to correlate the degree of pain relief with changes in the peak expiratory flow rate (PEFR) and oxygen saturation (Sao2). Methods Twenty-one consecutive adult patients admitted with rib fractures associated with severe pain formed the basis of the study. Chest pain was scored on a four-point scale before ICNB, 1 hour after ICNB, and 24 hours after ICNB. Sao2 was measured before and immediately after ICNB. PEFR was measured before and immediately after ICNB. Results Pain score and PEFR before and after ICNB showed statistically significant differences (p = 0.0000, df = 20). There was a significant difference between Sao2 before and after ICNB. Conclusion Significant increases in Sao2 and PEFR occur after ICNB with 0.5% bupivacaine, which also provides sustained analgesia, leading to improvement in respiratory mechanics.