This leaflet will explain what regional analgesia will involve. It explains the risks and the benefits that you can expect when you come to hospital. If you have any other questions or concerns, please do not hesitate to speak to the team caring for you. In all cases, a clinician will answer any questions you may have.

What is regional analgesia?

Regional analgesia is for patients who have rib fractures and are still experiencing moderate to severe pain despite the use of regular pain killers (either oral or through your drip). The medical team may think you will benefit from regional analgesia (otherwise known as a nerve block).

Nerve blocks help to numb the pain. This is done by injecting local anaesthetic to surround the nerves carrying pain signals thus providing good pain relief in that affected area.

A nerve block should allow you to reduce the number of other painkillers you require, meaning you get fewer side effects from these drugs. An anaesthetist will assess you to decide if a regional anaesthetic technique is appropriate and will discuss this with you.

The choice of technique will depend on several factors which will be assessed by the anaesthetist. In each of these cases – the nerves supplying the chest which carry pain signals (because of your fractured ribs) can be targeted at different sites to help numb the pain.

The technique of regional analgesia can be delivered as a single injection or by leaving in a fine plastic tube (called a catheter) near the nerves through which you will receive a continuous infusion of local anaesthetic for prolonged pain relief.

Management of rib fractures

There is no specific treatment for rib fractures. Pain management is vital in supportive care and especially important in the first few days following the injury. In addition to your medical team, the pain team will see you to assess whether your pain is being adequately controlled.

In some circumstances, where the pain from rib fractures cannot be treated adequately with oral or intravenous pain relief, you will be referred to the anaesthetic team for assessment for regional analgesia.

Why is pain relief important in the management of rib fractures?

Injuries to the chest can be painful. Unlike other parts of the body, you cannot rest your chest because you use it when you breathe, and it supports you when you sit up and lie down.

Pain is one of the main problems experienced after rib fractures. The severity of pain is dependent on the type of injury and how badly you have been hurt. Uncontrolled pain can prevent you taking deep breaths, coughing, and moving which may increase your chances of complications such as chest infections and limit your ability to partake in physiotherapy.

How is a nerve block preformed?

The nerve block is performed by an anaesthetist in a theatre setting (which maybe the operating theatre or an anaesthetic room).

Before performing the nerve block, the anaesthetic team will:

  • Check your consent form.
  • Attach monitoring.
  • Insert a cannula (drip).
  • Help you to get into the best position for the procedure (this maybe sitting up, laying on your side or laying on your back)

During the procedure

The area where the catheter will be inserted will be cleaned using a cold antiseptic. Local anaesthetic will be injected into the skin to help numb the area prior to the nerve block being done.

An ultrasound machine will be used to help guide the needle to the right place where the nerve block catheter can be left, and the needle will be removed.

The catheter is secured to the skin with special glue and a dressing. It’s connected to a pump which will deliver the local anaesthetic at a set rate to provide constant pain relief

After the procedure

You will be taken back to the ward. The pain team will review you the following day. The catheter will remain in for a few days and assessed daily

Regional analgesia risks

You will be explained the risks of the nerve block by the anaesthetist. You will be monitored for the risks carefully and regularly and if there are any issues – the anaesthetic team will be notified urgently.

Risks are rare but can include:

  • Pain at the injection site.
  • Infection.
  • Bleeding.
  • Nerve damage.
  • Failure of the nerve block.
  • Local anaesthetic toxicity.
  • Catheter dislodgement and blockage.
  • Pneumothorax (collapsed lung). This is extremely rare.