Background and Aims Costal fractures are a significant cause of morbidity in polytrauma patients. Poor pain control contributes directly to the appearance of complications. Multimodal analgesia is highly recommended for optimal treatment. We aimed to review the pain management of costal fractures in our center during 2021-2022.

Methods We reviewed all the polytraumatized patients admitted to our center during 2021 and 2022, selected those with costal fractures described in chest x-ray or CT-scan and described the analgesic strategy used within the first 48 hours. We also evaluated the analgesic quality by the need of rescue analgesia (opioid vs non opioid) and the appearance of complications related to analgesia.

Results 31 of 220 polytraumatized patients had costal fractures. All of them received an intravenous regime (IV) and only in 4 of them (13%) an only regional technique (RA) was performed: 3 ECI (epidural continuous infusion) and 1 ESP (erector spinae plane) continuous block. From this 4 patients, 3 had unilateral fractures and 1 had 13 (bilateral) fractures. There was only one complication associated in the RA group and no complications in the IV alone group. 90% of the patients had good pain control and did not need rescue analgesia. 3 of the 30 patients (10%) needed an analgesic rescue.

Conclusions Multimodal analgesia is chosen in our clinical practice for pain control with good results. A shift towards RA techniques was made in 2022 in patients with numerous fractures (more than 6), even though is not exempt from complications.