Multilevel Continuous Intercostal Nerve Block Catheter: A Viable Alternative to Thoracic Epidural for Multiple Rib Fractures?

摘要

To the Editor: It was with great interest that we read the article by Ahn et al. titled "Case Scenario: Pain-associated Respiratory Failure in Chest Trauma." The acute pain service at our hospital, which is one of only two level-one trauma centers in Houston, Texas, is frequently consulted for management of multiple rib fracture patients with impending respiratory failure. In patients who meet criteria, a thoracic epidural can be amazing in the setting of rib fractures. Unfortunately, many patients, like the one described by the authors, do not meet criteria established by recommendations of the American Society of Regional Anesthesia and Pain Medicine.2 This is secondary to trauma-associated coagulopathies, preadmission anticoagulation pharmacotherapy, or deep vein thrombosis prophylaxis initiated during their hospital admission. Moreover, in trauma patients who are eligible, thoracic epidurals can be difficult to place technically because optimal positioning for the procedure can be difficult in these patients. In addition, a working thoracic epidural may cause motor weakness in patients already at higher risk for deep vein thrombosis and may cause hypotension in patients with multitrauma.