Ribs 2-12 form the lateral thoracic cage, each with a head (two articular facets for adjacent vertebral bodies), neck, tubercle (for costotransverse joint), and shaft. The typical ribs (3-9) have all these features; floating ribs (11-12) have no tubercle or costotransverse joint. Each rib contains a neurovascular bundle (intercostal nerve, artery, vein) in the subcostal groove along the inferior inner border — 'Remember VAN': Vein superior, Artery middle, Nerve inferior.
Intercostal nerve blocks are placed at the rib angle with the needle directed slightly cephalad to stay in the subcostal groove above the nerve. Rib fractures produce pleuritic chest pain — three or more consecutive fractures produce flail chest requiring mechanical ventilation. Epidural analgesia or thoracic paravertebral block provides superior pain control for multiple rib fractures compared to systemic analgesia.
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