A comparative study of the effect of interpleural block with pethedine and intercostal block with bupivacaine on pulmonary function in patients with rib fractures

Background: Rib Fracture does not usually require surgical intervention, using various
pain management methods including nerve blocks reduce pain and improves pulmonary
function. In a single blind clinical trial study, we compared intercostal block and interpleural
block regarding their effects on pulmonary function in rib fracture.
Methods and Materials: 86 patients with unilateral fracture of more than two ribs in the
range of 20-50 years, presented to Khatam-al-anbia hospital from 1380 to 1382, were
randomly divided into two groups: intercostal block (40) and interpleural block (46). In the
intercostal block group, the patients received 3ml of bupivacaine 0.25% and in the
interpleural block group; the patients received 2mg/kg of pethidine after increasing the
volume to 20 ml. The procedures repeated every 8 hours for 48 hours. Pulmonary function
was evaluated by FEV1 and FVC using spirometry.
Results: Patients in the intercostal block group were 40 (23 males and 17 famales) and in
the interpleural block group 46 (26 males and 20 females) .The average age of the patients in
the intercostal and interpleural group was 31.15 and 32.76 years, respectively.
In both groups pulmonary function (FEV1and FVC) improved after block but comparison of
the two groups revealed better results in the interpleural group (78.60 vs 74.90 for FEV1 with
P<0.01 and 78.56 vs 75.17 for FVC with P<0.01 in the interpleural and intercostal group,
respectively). Mean FEV1 and FVC did not have a significant difference in the both groups
(66.21% in the interpleural block vs. 63.90 in the intercostal block for FEV1 and 66.39% in the
interpleural block vs. 64.33% in the intercostal block).
Conclusions: Both intercostal block with bupivacaine and interpleural block with pethidine
could improve pulmonary function in rib fracture. Although pulmonary function improvement
was statistically more significant in the interpleural block group, it does not seem to be
clinically significant.