Abstract
INTRODUCTION: Given the limitations of single-modality analgesia for rib fractures, this study aimed to determine whether combining systemic flurbiprofen axetil with a regional intercostal nerve block (ICNB) yields more effective and sustained preoperative pain relief than either technique used alone. METHODS: In this single-center, randomized, double-blind, controlled trial, 150 patients scheduled for surgery were allocated to one of three groups: Group F (flurbiprofen axetil + saline ICNB), Group FB (flurbiprofen axetil + ropivacaine ICNB), and Group B (saline + ropivacaine ICNB). The primary outcome was the Visual Analog Scale (VAS) score at quiet breathing 30 min post-intervention. Secondary outcomes included VAS scores at 6, 12, 18, and 24 h, rescue analgesia requirements, diaphragmatic excursion, arterial blood gas parameters, adverse events, and patient satisfaction. RESULTS: The FB group demonstrated significantly lower VAS scores at 30 min than the other groups (p < 0.001), along with significantly reduced rescue analgesia requirements across most time intervals (p < 0.05). No patients in the FB group required rescue thoracic paravertebral block versus eight in Group F (p < 0.001). The FB group also showed a significantly higher sum of pain intensity difference over 0-24 h (SPID(0-24h)), improved diaphragmatic excursion, higher oxygenation index, and greater patient satisfaction (all p < 0.001). The overall incidence of adverse events was low, with no serious complications reported. CONCLUSION: The combination of flurbiprofen axetil and ultrasound-guided ICNB provided superior preoperative analgesia than either agent alone, reduced rescue medication needs, improved respiratory function, and enhanced patient satisfaction, with a favorable safety profile in patients with traumatic multiple rib fractures. TRIAL REGISTRATION: The study protocol was registered at the Chinese Clinical Trial Registry with registration no. ChiCTR2500105786 ( https://www.chictr.org.cn ).