Rhomboid Intercostal Block for Analgesia of Multiple Rib Fractures in an Infant

Abstract

Rhomboid intercostal block (RIB) is a novel plane block, which is thought to provide analgesia for both the anterior and the posterior hemithorax. Herein, we represent the successful usage of ultrasound-guided RIB on an infant patient to provide analgesia for multiple rib fractures and insertion of a chest tube. A 10-month-old, 8 kg, male infant was scheduled for insertion of a chest tube. The patient had right sided pneumothorax and multiple rib fractures from T4 to T8 after a car crush. Following induction of anaesthesia, he was placed in lateral decubitis position and RIB was performed with 8mL 0.125% bupivacaine. A paediatric epidural catheter was placed into the interfacial plane for post-operative intermittent local anaesthetic injection as a part of multimodal analgesia with administration of intravenous paracetamol 60 mg. The postoperative pain assessment was conducted with FLACC scale at the post-operative 10th minute, 30th minute, 1st, 2nd, 6th, 12th and 24th hours, and the Face, Legs, Activity, Cry, Consolability scale score was <= 2 at all time-points. Ultrasound-guided RIB provided effective analgesia for insertion of a chest tube and attenuation of pain due to multiple rib-fractures in our infant patient.