Evaluation of Intercostal Neuralgia in Patients With Chest Tube Insertion After Traumatic Rib Fracture

Sunnybrook Health Sciences Centre

Status

Not yet enrolling

Conditions

Intercostal Nerve Injury

Treatments

Procedure: Chest tube insertion

Study type

Observational

Funder types

Other

Identifiers

NCT07308587

SUN 6775

Details and patient eligibility

About

Traumatic rib fractures are common injuries following blunt chest trauma, often requiring chest tube insertion to manage complications such as pneumothorax or haemothorax. However, chest tube placement can lead to intercostal nerve injury, resulting in intercostal neuralgia-a debilitating condition characterized by chronic, neuropathic pain along the intercostal nerves. Despite its clinical significance, the incidence, risk factors, and long-term outcomes of intercostal neuralgia in this patient population remain poorly understood.

Chronic pain following thoracic trauma, including intercostal neuralgia, has been shown to significantly impair quality of life and functional outcomes, leading to prolonged disability and increased healthcare utilization. Current literature highlights the need for better understanding and management of this condition, particularly in patients undergoing invasive procedures such as chest tube insertion. This study aims to prospectively evaluate the development of intercostal neuralgia in patients with chest tube insertion following traumatic rib fractures.

Full description

Intercostal neuralgia is defined as pain along the intercostal nerve distribution with neuropathic features. Chronic intercostal neuralgia is defined as having intercostal neuralgia symptoms for >3 months.

Intercostal neuralgia pain will be specifically differentiated from persistent rib fracture pain through the presence of neuropathic pain at the level of the chest tube/pigtail that is reproducible with brushing/light touch to the chest tube scar site.

The following data will be collected:

Baseline:

Demographic information (age, sex, ethnicity, comorbidities).
Pain assessment using numerical rating scale at rest and with deep inspiration
Pre-existing chronic pain conditions (e.g., fibromyalgia, chronic regional pain syndrome) and history of prior thoracic surgery or chest tube insertion.
Injury characteristics (mechanism of injury including presence of foreign bodies and additional penetrating injuries, number and location of rib fractures, associated injuries including vertebral body fractures, sternal fracture, transverse process fracture).
Chest tube / pigtail details (size, insertion site, duration of placement).
Spirometry testing including forced vital capacity (FVC) and forced expiratory volume (FEV1) at time of enrolment of study

Additional information to be collected following hospital stay:

Analgesic use including dose of opioids, use of regional anesthesia techniques, and adjunct analgesic medications while in hospital
Length of hospital stay
Presence and duration of mechanical ventilation
Number of surgeries

Follow ups: 1 (± 3 days) and 3 months (± 1 week) via telephone

Pain assessment using the numerical rating scale at rest and with deep inspiration
S-LANSS for neuropathic pain
EQ-5D-5L for health related quality of life
PROMIS sleep disturbance 6a for sleep
Medication use (analgesics, neuropathic pain medications)

Patients who are found to have intercostal neuralgia at 3 month follow up assessment can be referred to the pain clinic and choose to be sent for formal ultrasound to identify and characterize findings to indicate the presence of neuroma (a non-cancerous tumor or growth of nerve tissue), degree of scarring, or any other pain generating causes, if agreed. Participants' preferences regarding the disclosure of neuroma, including their right to know or not to know, will be respected (as described in the consent form).

Enrollment

100 estimated patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Adults (≥18 years) with traumatic rib fractures requiring chest tube insertion
Chest tube or pigtail insertion performed during their initial hospitalization for trauma

Exclusion criteria

Patients with traumatic brain injury
Patients with spinal cord injury
Inability to complete follow-up assessments (e.g., language barriers, lack of telephone access)

Exclusion Criteria:

Patients with traumatic brain injury
Patients with spinal cord injury
Inability to complete follow-up assessments (e.g., language barriers, lack of telephone access)