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Cirujano general

versión impresa ISSN 1405-0099

Resumen

TORRES MENDEZ, Rocío; VEGA RIVERA, Felipe  y  ACUNA PRATS, Rafael. Radiofrequency ablation of intercostal nerves for pain management in multiple rib fractures. Cir. gen [online]. 2020, vol.42, n.1, pp.24-30.  Epub 24-Sep-2021. ISSN 1405-0099.  https://doi.org/10.35366/92708.

Introduction:

Trauma continues to be a major problem that is confronted daily by doctors, surgeons and the emergency systems in general, particularly in blunt thoracic trauma. The pain that the patients have usually is severe restricting in an important way the ventilation and furthermore it generally produces lung atelectasis and neumony because the patients can't move lung secretions. The main objective of this article is to show that the use of intercostals nerve ablation diminishes the pain of the patient with blunt thoracic trauma by the review of the first 12 cases of blunt thoracic trauma with multiples rib fractures treated with radiofrequency ablation of the intercostal nerves guided by fluoroscopy or ultrasound and electric impedance in order to diminish the pain before or after surgery.

Material and methods:

It was a retrospective study of 12 patients with blunt thoracic trauma who had difficulties with the ventilation because of the intensity of the pain. The cause of the trauma were car and motorcycle accidents, falls form different heights (10-25 m). The patients had general anesthesia and intubation before the procedure followed by ablation of the intercostal nerves proximal to the rib fracture guided by fluorosocopy or ultrasound and impedance. The correct placement of the needle was done by electric impedance and motor and sensory stimulations. The nerve ablation of the intercostals nerves of the rib fractures were done with 60 oC for one minute for each nerve using the NeuroTherm NT 1100 (registered marc). Variables: qualitative variables used for description of the population was accomplished by age, gender, mechanism of the trauma. Pain intensity was measured by the quantitative pain number scale before and after the treatment and with exhalation, before and after treatment, quantitative variables studied: number of rib fractured, injured severity scale score, and revised trauma score, morphine use in mg before and after the treatment description of the result by average and standard deviation.

Results:

Pain intensity was diminished in 70%, and the daily morphine consumption was also diminished in 70.8%. Alodine as a complication of the treatment was found in a 41.2% of the cases and was easily controlled with gabapentinoids for two weeks.

Conclusion:

The use of intercostal nerve ablation with radiofrequency in thoracic blunt trauma is effective and safe. It controls the pain significantly and improves the ventilation of the patient diminishing the morphine consumption. This technique could become the new gold standard in the treatment of pain in the severe thoracic blunt trauma.

Palabras llave : Pain; intercostal nerve ablation; blunt thoracic trauma.

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