Background and aims Rib fractures are a major cause of trauma morbidity and mortality. Analgaesia is paramount, as uncontrolled pain leads to hypoventilation with its attendant complications. Regional anaesthesia (RA) is the standard of care; it is often underutilised. Provided no contraindication, NHS England stipulates that RA is provided within 6 hours of radiological diagnosis. This audit evaluates current practice at a London major trauma centre.
Methods Data were obtained from the Trauma and Audit Research Network database over 3 months commencing October 2018 for patients with ≥3 rib fractures or chest drain. We recorded time from diagnosis to consideration and performance of RA, and qualitative data on choice of analgesia, service delays and complications.
Results 37 patients were admitted; 28/37 male, aged 68.8 yrs (55.6–79.8), ISS 24 (17–34). We excluded 4 patients without valid identifiers; a further 3 had unsurvivable injuries. In 11/30 RA was considered within 6h, rising to 18/30 in total (range 0->140h), with 7/30 eventually receiving RA. In 10/23 epidural/PVB was contraindicated. Some received sequential procedures: initial failure, or single-shot temporization followed by catheter. Reasons for non-provision are documented in figure 1. In 7/7 patients, RA was delayed >24h from diagnosis.
RA considered early in majority of cases; <25% received
Adequacy of early pain control often undocumented
Risk–benefit documentation lacking for relative contraindications
Documented shortage of anaesthetic/theatre capacity in a few (but likely accounts for more) lost–to–RA cases
Expanding service capacity and improving out–of–hours provision may help
Many have contraindications, suggesting a role for emerging novel chest wall blocks SA/ESP
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