Incidence of pneumothorax from intercostal nerve block for analgesia in rib fractures

Background. The incidence of pneumothorax (PTX) after individual intercosta l nerve block (INB) for postoperative pain reportedly varies from 0.073% to 19%.(1-3) This study investigated the incidence of PTX after INB for rib f ractures. Methods: We conducted a retrospective chart review of patients admitted bet ween January 1996 and December 1999 with rib fractures who received INB. Results: One hundred sixty-one patients received 249 intercostal nerve bloc k procedures (INBPs). An INBP is one session where a set of intercostal ner ves are blocked. A total of 1,020 individual intercostal nerves were blocke d. There were 14 pneumothoraces. The overall incidence of PTX per patient w as 8.7%, with an incidence of PTX per INBP of 5.6%. The incidence of PTX wa s 1.4% for each individual intercostal nerve blocked. Conclusion. The incidence of PTX per individual intercostal nerve blocked i s low. INB is an effective form of analgesia, and for most patients with ri b fractures one INBP is sufficient to allow adequate respiratory exercises and discharge from the hospital.