Thoracic Intervertebral Foramen Blocks Compared to Midpoint‐to‐Pleura Transverse Process Blocks for the Management of Acute Rib Fracture Pain

BACKGROUND: Rib fractures can lead to intense acute pain, chest wall instability, and pulmonary complications in trauma patients, necessitating their admission to critical care units. Furthermore, these lesions represent a source of neuropathic disturbances. OBJECTIVES: The goal was to compare continuous thoracic intervertebral foramen blocks (CTIFBs) to continuous midpoint-to-pleura transverse process blocks (CMTPBs), both guided by ultrasound, for their efficacy in managing acute pain caused by rib fractures. STUDY DESIGN: A double-blind, randomized controlled trial. SETTING: This research was conducted in the Intensive Care Unit (ICU) of San Salvatore Academic Hospital (L'Aquila, Italy) from December 2022 to November 2024. METHODS: Ninety-six adult trauma patients with rib fractures were randomized to receive either the CTIFB (experimental group; n = 48) or the CMPTB (control group; n = 48). The former block was performed by placing the tip of the needle over and behind the transverse process of the vertebra. In the latter block, the needle tip involved the midpoint between the pleura and transverse process. All patients received an initial bolus of 5 mL of levobupivacaine 0.25% with 4 mg of dexamethasone at each fracture level, followed by a continuous infusion (5 mL/h of levobupivacaine 0.25% with 16 mg of dexamethasone). The primary outcome was the proportion of patients who achieved pain control (Numeric Rating Scale [NRS] score