Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Pain arising from traumatic rib fracture contributes to significant patient morbidity and mortality.
CASE REPORT: A 68-year-old man with multiple comorbidities presented to the emergency department with a left-sided multiple rib fracture (ribs 6-8) and altered mental status after an unwitnessed fall. The patient was started on a standard of care oral analgesic regime, but continued to deteriorate because of inadequate pain relief in his pulmonary function. Given his altered mental status and insufficient pain control, to facilitate pulmonary physiotherapy, we performed an early (day 5) thermal radiofrequency ablation (RFA) of intercostal nerves at 80 ºC for 90 seconds each level. Significant pain relief was noted on the same day of the procedure (pain score - 1/10).
CONCLUSIONS: This case report demonstrates the feasibility and efficacy of early thermal RFA of intercostal nerves in a frail elderly patient with multiple rib fractures and delirium in the acute pain setting.
KEY WORDS: Rib fracture, radiofrequency, denervation, intercostal nerve, acute pain