930 - Traumatic Sternal Fracture Pain Successfully Managed with Ketorolac Intercostal Nerve Injections

87-year-old female involved in motor vehicle collision sustained an oblique sternal body fracture. The patient was presented with 10/10 sternal pain. The patient also had difficulty with inspiration due to the severe pain.  10 mg of oxycodone was given with minimal pain relief.  

The patient was diagnosed with acute traumatic pain due to the sternal body fracture. Parasternal intercostal nerve blocks with 15 mg of ketorolac and 2% lidocaine were injected on the left side at the intercostal spaces 2, 3, and 4 under anatomic guidance. Within 24 hours the patient’s pain improved to 1/10 on VAS. Another parasternal intercostal nerve blocks with the same ketorolac/lidocaine mixture were injected to the right side at intercostal spaces 2, 3, and 4 two days later.   The p</span>atient’s sternal pain continued to improve and was rarely taking oxycodone.  The patient was able to participate in daily therapy without pain and was discharged home.  


Discussions: Sternal fracture pain are often sharp and intense, and sometimes difficult to manage.   Common pain regimens include acetaminophen, NSAIDs, opioids, and topical medications are generally prescribed and sometimes effective. Intercostal nerve blocks with lidocaine alone or with corticosteroids can also be used to treat sternal pain. However, the pain relieved generally lasts about hours to days with this injection formulation.  Intramuscular injections with ketorolac have been published with effectiveness; however, ketorolac intercostal nerve block injection has never been reported. To our knowledge, this is the first reported case to demonstrate effectiveness and tolerance of ketorolac nerve blocks with at least two week pain relief from the injection. This administration into the intercostal space and nerve also minimizes the systemic effect of ketorolac. 

Conclusions: This is the first reported case, to our knowledge, of using ketorolac intercostal nerve blocks for sternal fracture pain.