Best Evidence Topics
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Intercostal nerve block for chest drain insertion

Three Part Question

In [patients with acute chest trauma requiring a chest drain] does [intercostal block] provide lower [pain scores]

Clinical Scenario

A 35 year old patient is hit in the chest with a baseball bat sustaining multiple rib fractures and a haemothorax that requires insertion of a chest drain. You wonder if interpleural block is more effective than standard care at providing analgesia.

Search Strategy

Medline 1966-09/2016 using the Pubmed interface
(Chest Drain OR Intercostal Drain OR Interpleural Drain) AND (Intercostal block OR Intercostal nerve block OR Interpleural block OR Interpleural nerve block) AND (Pain OR Pain) LIMIT to human AND English language.

Search Outcome

11 papers, only one of which was applicable to the three part question.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Anyanwu CH, Swarup AS.
145 patients with chest injuries seen in the Cardiothoracic Surgical Unit of UNTH Enugu between January 1975 and September 1979 (4 years)Retrospective case seriesNo discussion of analgesic efficacy


There are no English language papers providing comparison between local and regional analgesia for the insertion of chest drain.

Clinical Bottom Line

This is an evidence free zone.


  1. Anyanwu CH, Swarup AS. Chest trauma in a developing country. Ann R Coll Surg Engl 1981 Mar;63(2):102-4.