Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture technique
Background Surgical stabilization of rib fractures (SSRF) has been shown to improve outcomes, yet there is an absence of studies comparing SSRF techniques. An intrathoracic system that minimizes incision length has recently been developed and adopted by multiple institutions. We hypothesized that SS...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/8/1/e001201.full |
| _version_ | 1797367227724333056 |
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| author | Michael Fitzgerald Christopher Watson Michael Tichenor Laura B. Reparaz Jeremy Reeves Phillip Prest Neema Patel Xiyan Tan Jacob Hessey |
| author_facet | Michael Fitzgerald Christopher Watson Michael Tichenor Laura B. Reparaz Jeremy Reeves Phillip Prest Neema Patel Xiyan Tan Jacob Hessey |
| author_sort | Michael Fitzgerald |
| collection | DOAJ |
| description | Background Surgical stabilization of rib fractures (SSRF) has been shown to improve outcomes, yet there is an absence of studies comparing SSRF techniques. An intrathoracic system that minimizes incision length has recently been developed and adopted by multiple institutions. We hypothesized that SSRF with an intrathoracic system plus intercostal nerve cryoneurolysis (IC) leads to improved pain control compared with an extrathoracic system plus IC.Methods A single-center, retrospective chart review was performed comparing intrathoracic SSRF versus extrathoracic SSRF, and included patients undergoing SSRF from 2015 to 2021 at a level 1 trauma center. Patients who did not undergo intercostal nerve cryoablation were excluded. The primary outcome was opioid consumption based on morphine milligram equivalent (MME) consumption. We collected Rib score, Blunt Pulmonary Contusion 18 Score, number of rib fractures, number of ribs plated, and Injury Severity Score (ISS) to compare baseline characteristics of each group.Results A total of 112 patients were evaluated for study inclusion. Thirty-one patients were excluded due to missing outcomes data and/or lack of cryoablation. There was no difference in ISS or Rib Score between the intrathoracic (n=33) and extrathoracic (n=48) groups. At 7-day follow-up, the median MME requirement was significantly lower in the intrathoracic group (21.25) versus the extrathoracic group (46.20) (p=0.02).Conclusion Intrathoracic SSRF was associated with a lower postoperative MME consumption compared with extrathoracic SSRF. These data support the use of intrathoracic SSRF to improve pain control compared to extrathoracic SSRF.Level of evidence III. |
| first_indexed | 2024-03-08T17:15:18Z |
| format | Article |
| id | doaj.art-e3e401f86abb45d6b3e39b7508ec2078 |
| institution | Directory Open Access Journal |
| issn | 2397-5776 |
| language | English |
| last_indexed | 2024-03-08T17:15:18Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj.art-e3e401f86abb45d6b3e39b7508ec20782024-01-03T15:50:08ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762023-11-018110.1136/tsaco-2023-001201Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture techniqueMichael Fitzgerald0Christopher Watson1Michael Tichenor2Laura B. Reparaz3Jeremy Reeves4Phillip Prest5Neema Patel6Xiyan Tan7Jacob Hessey8Department of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USADepartment of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USADepartment of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USADepartment of Trauma Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USADepartment of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USADepartment of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USADepartment of General Surgery, Mount Sinai South Nassau, Oceanside, New York, USASchool of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina, USADepartment of Surgery, Prisma Health Richland Hospital, Columbia, South Carolina, USABackground Surgical stabilization of rib fractures (SSRF) has been shown to improve outcomes, yet there is an absence of studies comparing SSRF techniques. An intrathoracic system that minimizes incision length has recently been developed and adopted by multiple institutions. We hypothesized that SSRF with an intrathoracic system plus intercostal nerve cryoneurolysis (IC) leads to improved pain control compared with an extrathoracic system plus IC.Methods A single-center, retrospective chart review was performed comparing intrathoracic SSRF versus extrathoracic SSRF, and included patients undergoing SSRF from 2015 to 2021 at a level 1 trauma center. Patients who did not undergo intercostal nerve cryoablation were excluded. The primary outcome was opioid consumption based on morphine milligram equivalent (MME) consumption. We collected Rib score, Blunt Pulmonary Contusion 18 Score, number of rib fractures, number of ribs plated, and Injury Severity Score (ISS) to compare baseline characteristics of each group.Results A total of 112 patients were evaluated for study inclusion. Thirty-one patients were excluded due to missing outcomes data and/or lack of cryoablation. There was no difference in ISS or Rib Score between the intrathoracic (n=33) and extrathoracic (n=48) groups. At 7-day follow-up, the median MME requirement was significantly lower in the intrathoracic group (21.25) versus the extrathoracic group (46.20) (p=0.02).Conclusion Intrathoracic SSRF was associated with a lower postoperative MME consumption compared with extrathoracic SSRF. These data support the use of intrathoracic SSRF to improve pain control compared to extrathoracic SSRF.Level of evidence III.https://tsaco.bmj.com/content/8/1/e001201.full |
| spellingShingle | Michael Fitzgerald Christopher Watson Michael Tichenor Laura B. Reparaz Jeremy Reeves Phillip Prest Neema Patel Xiyan Tan Jacob Hessey Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture technique Trauma Surgery & Acute Care Open |
| title | Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture technique |
| title_full | Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture technique |
| title_fullStr | Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture technique |
| title_full_unstemmed | Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture technique |
| title_short | Intrathoracic plates versus extrathoracic plates: a comparison of postoperative pain in surgical stabilization of rib fracture technique |
| title_sort | intrathoracic plates versus extrathoracic plates a comparison of postoperative pain in surgical stabilization of rib fracture technique |
| url | https://tsaco.bmj.com/content/8/1/e001201.full |
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