Background and aims Inadequate analgesia in rib fractures can lead to increased respiratory complications resulting from hypoventilation due to pain. The current Bedford Hospital NHS Trust Guideline (‘Analgesia for the management of rib fractures’) recommends pain relief options based on the grade of severity of rib fractures. An audit was carried out with the following aims:
To measure compliance with the Trust Guideline.
To assess the proportion of patients with each grade of injury being treated with appropriate analgesia as per the guideline.
Methods Data was collected retrospectively between 01/01/18 and 28/02/19. During this time 24 patients were referred to the pain team with rib fractures, of whom 14 received regional blocks. The medical records and medication charts relating to these admissions were reviewed.
Results Compliance with the guideline was good: all patients received simple analgesia as a minimum. 1 thoracic epidural, 7 erector spinae plane blocks and 5 serratus plane blocks were performed, resulting in reduced pain scores and decreased administration of prn analgesia (see figure 1).
Conclusions Peripheral nerve blocks seem to be an effective and less invasive alternative to thoracic epidurals especially for unilateral rib fractures and patients receiving anticoagulation. The serratus plane block is useful for anterior fractures and is easier to perform in the supine position, with less discomfort to patients. The erector spinae block is useful for posterior fractures but is more difficult to perform as it involves moving the patient. These newer fascial plane blocks seem to be safe as no major complications have been reported yet.
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