Thoracic Epidural and Intercostal Nerve Cryoablation in Multimodal Analgesia for Acute Pain Management of Rib Fractures: A Case Report.

Acute pain service was consulted for acute pain management in a 40-year-old male who had sustained multiple bilateral rib fractures following a fall injury. In addition to the rib fractures, the patient had also experienced injuries to his lungs and spinal column, both of which required surgeries. Considering the significant nature of pain due to his rib fractures, a multimodal pain management approach that included both pharmacological and non-pharmacological strategies was utilized. A thoracic epidural was performed by the acute pain service to provide immediate onset analgesia, especially during his stay in the hospital. At the same time, the surgeon performed thoracic intercostal nerve cryoablation, where nerves are frozen to prevent them from sending pain signals to the brain to provide analgesia for the patient even after getting discharged from the hospital. Both were done during a perioperative period. The cryoablations complemented the epidural, and they ensured continuous pain control in this patient. This report is unique as literature on utilizing both thoracic epidural and intercostal nerve ablations as part of a multimodal pain management approach for rib fractures is sparse.