In patients with multiple rib fractures, does minimally invasive pulsed radio frequency ablation offer benefits in comparison to surgical stabilization of fractures?

The database was obtained from Acute Pain Service and Trauma Registry from CGMH and data was collected from patients with non-flail rib fractures, who underwent pRF treatments from 2020/01/01 to 2025/05/30. Pulsed radio frequency (pRF) to intercostal nerves in patients with multiple no flail rib fractures who didnot require surgical correction. PRF is a minimally invasive procedure that provides neuromodulation to nerves in reducing pain perception. In this study, pRF would be carried out in rib fractured patients regardless of their involvement in the study. pRF would be performed as per protocol by only two experienced anesthesiologists/pain practitioners. During pRF, the levels of the fractured ribs were initially identified using computed tomography (CT) and chest radiography. Rib position and intercostal anatomy were further confirmed with ultrasound imaging (Sonosite, WA, USA). Patients were positioned in either the sitting or prone position, and the operative field was prepared with chlorhexidine before sterile drapes were applied. All interventions were performed under strict aseptic technique. Local anesthesia with 2% lidocaine was infiltrated at each planned entry site. A 10-cm, 22-gauge radiofrequency (RF) cannula with a 5-mm active tip (Abbott Medical, Plymouth, MN, USA) was then advanced under ultrasound guidance to the target intercostal nerve corresponding to the fractured rib. Sensory stimulation at 50 Hz was used to confirm accurate localization by reproducing paresthesia within the appropriate intercostal nerve distribution, and electrode positioning was optimized accordingly. Pulsed radiofrequency (pRF) ablation was performed using a Neurotherm NT1100 generator (St. Jude Medical, Minnetonka, MN, USA) at 2 Hz with a 20-millisecond pulse width for 180 seconds at 45 V, with temperature below 42°C. Upon completion, 1 mL of a mixture containing 0.5% ropivacaine and 1 mg dexamethasone was injected perineurally prior to removal of the RF cannula at each treatment site. The procedure on average lasted for 1-2 hours depending on the number of fractured ribs.