<p>Comparative effectiveness analysis of two regional analgesia techniques for the pain management of isolated multiple rib fractures</p>

Abstract

Background: Catheter-based regional analgesia has been proposed as an alternative to systemic analgesia for patients with multiple rib fractures (MRF). This study sought to compare the efficacy of regional techniques for decreasing pain and improving clinical outcomes. Study design: This was a multi-institutional, retrospective cohort study of adult (≥18 years) patients admitted to four nonacademic trauma centers over two years (from 07/1/2014 to 06/30/2016). Study inclusion was MRF (≥3 fractures) with no other severe injuries. Two primary regional analgesia techniques were utilized and compared: continuous intercostal nerve blocks (CINB) and epidural (EPI) analgesia. The primary outcome, average pain scores on treatment, was examined using a repeated measures, linear regression mixed model. Secondary outcomes included hospital LOS, ICU LOS, ICU admission and hospital readmission, pulmonary complications, and incentive spirometry volumes during treatment, and were examined with univariate statistics. Results: There were 339 patients with isolated MRF; 85 (25%) required regional analgesia (CINB, n=41; EPI, n=44) and the remaining 75% received systemic analgesia only (IV, n=195; PO, n=59). There were demographic and clinical differences between regional analgesia and systemic analgesia groups; on the contrary, there were no demographic or clinical differences between the CINB and EPI groups. Adjusted pain scores were similar for the EPI and CINB groups (4.0 vs 4.4, p =0.49). Secondary outcomes were worse in the EPI group compared to the CINB group: less improvement in incentive spirometry volume ( p =0.004), longer ICU LOS ( p =0.03), longer hospital LOS ( p <0.001), and more ICU admission ( p <0.001). Conclusion: In patients requiring regional analgesia, pain management was equivalent with CINB and EPI, but CINB was associated with significantly better clinical outcomes. CINB might offer an efficient alternative for pain control in patients with MRF.

Assessing the analgesic efficacy of oral epigallocatechin-3-gallate on epidural catheter analgesia in patients after surgical stabilisation of multiple rib fractures: a prospective double-blind, placebo-controlled clinical trial

“…In MRF patients, local/regional analgesic techniques, compared to systemic analgesia, have been demonstrated to yield greater efficacy and fewer side effects (Karmakar & Ho 2003;Ho et al 2011). Epidural (EPI) catheter analgesia is currently the most frequently studied regional technique (Lynch et al 2019), and is recommended by the Eastern Association for the Surgery of Trauma and Trauma Anaesthesiology Society (Galvagno et al 2016). However, the studies associated with EPI analgesia have been controversial (Lynch et al 2019), thus warranting additional investigations to identify novel agents for further pain relief, especially in MRF patients after SSRF.…”

“…Epidural (EPI) catheter analgesia is currently the most frequently studied regional technique (Lynch et al. 2019 ), and is recommended by the Eastern Association for the Surgery of Trauma and Trauma Anaesthesiology Society (Galvagno et al. 2016 ).…”

“…However, the studies associated with EPI analgesia have been controversial (Lynch et al. 2019 ), thus warranting additional investigations to identify novel agents for further pain relief, especially in MRF patients after SSRF.…”

The Effects of Add-on Self-Care Therapy on Epidural Catheter Analgesia and Quality of Life in Patients after Surgical Stabilization of Multiple Rib Fractures

“…In patients with MRF, local or regional analgesic techniques, in comparison with systemic analgesia, have proved to yield fewer adverse effects and greater e cacy [8,9]. Currently, Epidural (EPI) catheter analgesia is a most commonly studied regional analgesic technique [10], and recommended by the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society [11].…”

“…However, studies have also pointed out various side effects intrinsically linked to EPI analgesia, and compromised patients' general well-being, such as decreased quality of life (QoL) [10,12,13]. Social behaviors are also greatly hindered by the side effects, often manifesting as social isolation, disrupted social role, or even depression.…”