Surgical pain control for rib fractures: Procedural options for acute and persistent pain

Rib fractures are among the most common injuries after blunt thoracic trauma and can cause severe pain and chest wall dysfunction, limiting ventilation, cough, and mobilization and increasing the risk of pulmonary complications. Although surgical stabilization of rib fractures (SSRF) can improve mechanics and pain in selected patients, many patients require additional procedural strategies, either as adjuncts to SSRF or as stand-alone options when fixation is not indicated or feasible. This review summarizes key operative and procedure-based approaches to rib fracture analgesia, including elastomeric infusion pumps and continuous intercostal catheter techniques, intercostal radiofrequency ablation, intercostal cryoneurolysis, intercostal neurectomy, and peripheral nerve stimulation. For each modality, we highlight device or technique evolution, proposed mechanisms, typical clinical scenarios and timing (acute versus persistent neuropathic pain), available evidence on effectiveness, and the most relevant complications and safety considerations. The goal is to provide a practical framework to help clinicians match interventions to patient factors, injury pattern, contraindications to regional anesthesia, and the expected duration and phenotype of pain, while supporting respiratory recovery and functional outcomes.