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EP184 Regional anaesthesia techniques for management of chest wall trauma in a Scottish tertiary major trauma centre: a retrospective service evaluation and outcome analysis
  1. Sofia Rosas,
  2. Jillian Scott,
  3. Jackie Bell,
  4. Stephanie Brockie,
  5. Freya Burwaiss,
  6. Stephen Hickey and
  7. Robert Hart
  1. Department of Anaesthesia and Critical Care Medicine, Queen Elizabeth University Hospital, Glasgow, UK


Background and Aims Chest wall trauma is a notorious anaesthetic challenge and high opioid analgesia requirements, hypoventilation, hypostatic pneumonia and respiratory failure are common complications. Regional anaesthesia (RA) techniques have emerged as good adjuncts to reduce opioid consumption. In this study we describe the demographic and outcome data of patients that have received RA for analgesic management of chest wall trauma.

Methods We retrospectively collected data from electronic health records on all patients with chest wall trauma who received RA techniques following acute pain team referral from October 2018 to August 2022.

Results We reviewed data from 187 patients. Mean age was 64.25 years, median fracture burden of 7 per patient, with 47 patients presenting with bilateral fractures and 88 having a flail segment (table 1). Of these patients, 131 received an erector spinae plane (ESP) block and 43 had serratus anterior plane (SAP) block with median block duration of 4 days. Twenty-two patients required high flow nasal oxygen at 24h of admission and 149 required critical care admission with 43 needing invasive ventilation and a median length of stay of 5 days (table 2). RA significantly reduced opioid consumption in 24 hours after procedure (20mg vs 14mg, p<0.01, figure 1) and 168 patients survived to hospital discharge.

Abstract EP184 Table 1

Summary demographics and characterisation of injuries at presentation Characteristics

Abstract EP184 Table 2

Description of regional anaesthesia techniques used and population outcomes

Abstract EP184 Figure 1

Comparison between opioid requirements 24 hours before regional anaesthesia technique (pre-RA) and for 24h after block (post-RA). Values shown are median of intravenous morphine equivalents in mg. N=137. Pre block requirements were significantly higher than post block when compared using Related-Samples Wilcoxon Signed Rank test (20mg vs 14mg, p<0.01, * – represents significant difference)

Conclusions The patient cohort presented had a high burden of chest wall injury and need for critical care resources. Our analysis demonstrated reduction in opioid consumption following RA techniques. Given the potential deleterious effects of opioid analgesia, RA should be offered to patients with significant chest wall trauma.

Ethics Approval

  • Chest wall trauma analgesia

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