Anaesthetic and surgical management of rib fractures

Williams, Adam; Bigham, Colin; Marchbank, Adrian

doi:10.1016/j.bjae.2020.06.001

Cited by 26 publications

(8 citation statements)

References 29 publications

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“…Thoracic epidurals have previously been viewed as the 'gold standard' in analgesic management of rib fractures and have been demonstrated to provide superior analgesia compared to intercostal blocks and intravenous analgesia [4]. However, growing evidence demonstrates analgesia can be provided by less invasive, more portable, and lower-risk alternatives such as paravertebral blocks, erector spinae plane blocks, and serratus anterior plane blocks [8,9]. One of the notable benefits of thoracic epidural analgesia is an ability to provide analgesia for bilateral rib fractures with a single procedure as opposed to the unilateral analgesia of other regional techniques.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Epidural as a Rescue Analgesic in a Patient with a Continuous Erector Spinae Plane Block for Rib Fractures: A Case Report

2023

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Unusual or unexpected effect of treatment Background:Rib fractures are a common traumatic injury with significant morbidity and mortality resulting from respiratory compromise. Regional anesthetic techniques have demonstrated efficacy in reducing morbidity and mortality from rib fractures, but there is limited evidence comparing various techniques, and in complex trauma patients various factors may preclude the use of neuraxial and other techniques. Case Report:We report the case of a 72-year-old man who presented with left 4 th -11 th rib fractures. He was initially managed with a continuous erector spinae plane catheter, which resulted in improved pain and incentive spirometry. Unfortunately, he continued to decline and ultimately was rescued from impending respiratory failure by placement of a T6-T7 epidural catheter and epidural infusion of bupivacaine. Conclusions:This case report suggests that a continuous erector spinae plane block may be a useful regional anesthesia technique in the management of rib fractures through its potential to improve pain control and increase incentive spirometry volumes. It also suggests that there may be limitations to its utility given the continued decline of the patient, who was eventually rescued from respiratory failure by placement of a thoracic epidural. Unique to erector spinae plane blocks are the ability to be managed in the outpatient setting, improved safety profile, ease of placement, and potential to be placed in patients with coagulopathy and on anticoagulation therapies.

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Section: Discussionmentioning

confidence: 99%

Thoracic Epidural as a Rescue Analgesic in a Patient with a Continuous Erector Spinae Plane Block for Rib Fractures: A Case Report

2023

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“…Unsurprisingly, pneumonia accounts for the majority of delayed mortality after chest wall trauma. 3 In patients over 65 years old, the morbidity and mortality from rib fractures rises dramatically. While thoracic epidurals and paravertebral blocks are efficacious in treating this acute pain, 4 ultrasound-guided fascial plane blocks, such as the erector spinae plane (ESP) block, have recently become popular as an alternative to neuraxial anesthesia.…”

Section: Glossarymentioning

confidence: 99%

Retrolaminar Continuous Nerve Block Catheter for Multiple Rib Fractures: A Case Report

Seol

Tsui

2022

A&A Practice

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Rib fractures carry high morbidity and mortality due to pain-related complications, such as hypoventilation, atelectasis, and pneumonia. Ultrasound-guided regional anesthesia is a common treatment for pain associated with rib fractures. But, due to a variety of reasons, ultrasound images can be ambiguous or unhelpful. In these instances, it is advantageous to have a tactile or landmark-based approach to treating rib fracture pain. We present a case of a continuous retrolaminar nerve block catheter placed without ultrasound guidance in a 67-year-old man with oxygen-dependent chronic obstructive pulmonary disease and a prior intrathecal pump, who presents with multiple unilateral rib fractures.

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“…Chest injuries contribute to 25% of deaths after trauma and survivors can experience long-standing consequences, such as reduced functional capabilities and loss of work. 1 The importance of early detection and aggressive management of rib fracture has been well described in the literature, especially in the older population. 2 In the elderly, trauma to the thorax represents the second most common site of injury and mortality rates are two to five times higher compared with their younger counterparts.…”

Section: Problemmentioning

confidence: 99%

“…Around 20% of patients admitted after trauma will have at least one rib fracture. Chest injuries contribute to 25% of deaths after trauma and survivors can experience long-standing consequences, such as reduced functional capabilities and loss of work 1. The importance of early detection and aggressive management of rib fracture has been well described in the literature, especially in the older population 2.…”

Section: Problemmentioning

confidence: 99%

Implementation of a chest injury pathway in the emergency department

et al. 2022

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Rib fractures represent a substantial health burden. Chest injuries contribute to 25% of deaths after trauma and survivors can experience long-standing consequences, such as reduced functional capabilities and loss of employment. Over recent years, there has been an increase in the awareness of the importance of early identification, aggressive pain management and adequate safety netting for patients with chest injuries. Substandard management leads to increased rates of morbidity and mortality. The development of protocols in the emergency department (ED) for management of patients with chest wall injuries has demonstrated reduction of complication rates.Our aim was to develop an evidence-based, multidisciplinary chest injury pathway for the management of patients presenting with rib injury to our ED.Prior to implementation of the pathway in our department, only 39% of patients were documented as having received analgesia and only 7% of discharged patients had documented written verbal advice. There was no standardised method to perform regional anaesthetic blocks. Using quality improvement methods, we standardised imaging modality, risk stratification with a scoring system, analgesia with emphasis on regional anaesthesia blocks and disposition with information leaflets for those discharged.Implementation of the pathway increased rates of documented analgesia received from 39% to 70%. The number of regional anaesthetic blocks performed went from 0% to 60% and the number of patients receiving discharge advice went from 7% to 70%. Compliance of doctors and nurses with the pathway was 63%.Our previous audits showed substandard management of patients with chest injuries in our department. Through this quality improvement project, we were able to improve the quality of care provided to patients attending with rib fractures by increasing rate of analgesia received, regional blocks performed and discharge advice given.

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Anaesthetic and surgical management of rib fractures

Cited by 26 publications

References 29 publications

Thoracic Epidural as a Rescue Analgesic in a Patient with a Continuous Erector Spinae Plane Block for Rib Fractures: A Case Report

Thoracic Epidural as a Rescue Analgesic in a Patient with a Continuous Erector Spinae Plane Block for Rib Fractures: A Case Report

Retrolaminar Continuous Nerve Block Catheter for Multiple Rib Fractures: A Case Report

Implementation of a chest injury pathway in the emergency department

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