Medicating the cage: Pain management of rib fractures

摘要

Common practice in the management of rib fractures is a combination of pain control and pulmonary hygiene. Morbidity and mortality caused by rib fractures is the result of three main problems: altered breathing mechanics secondary to splinting, hypoventilation caused by uncontrolled pain, and impaired gas exchange as a result of underlying lung parenchyma damage. The chest pain caused by a patient’s rib fractures often significantly limits the patient’s ability to cough and breathe deeply, leading to pulmonary complications. This splinting contributes to an increased risk of pneumonia, acute respiratory distress syndrome, and respiratory failure, which can lead to a longer hospital length of stay and even death. The morbidity and mortality rates associated with rib fractures have been found to be greater in patients older than 65 years of age, patients with more than three rib fractures, and in those individuals who have premorbid cardiopulmonary disease.1