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Ultra-sound Guided Intercostal Neurolysis for Intractable Pain Arising out of Rib Fracture

Arif Ahmed*, Divesh Arora, Amit Kochar and Niti Gulati

Introduction: Rib fracture from blunt chest trauma leads to considerable morbidity, which increases with each rib fracture. There are multiple methods of pain relief from rib fracture, but most of them are effective for short duration and in acute pain setting. In a few patients, whom the pain becomes chronic, the treatment could be difficult. In this case report, we are describing a patient with severe chest pain arising out of 1st to 11th rib fracture, whose pain was not controlled even after multiple interventions and was on multiple medications.

Case presentation: We had done ultrasound guided intercostal neurolysis of 1st to 11th intercostal nerve with 2 ml of 50% alcohol, after having more than 80% relief from the ultrasound guided diagnostic intercostal block at all the levels. After the neurolysis, there was good pain relief of chest pain, and the patient was able to take deep breaths and do chest physiotherapy. The pain relief from the neurolysis lasted for more than 6 months .There was no immediate and delayed complications after the procedure.

Conclusion: The Ultrasound guided intercostal neurolysis can be a good long lasting alternative for the patients with uncontrolled severe pain from rib fracture.