Adults aged ≥60 years now represent the majority of patients presenting with major trauma. Falls are the most common cause of injury, accounting for nearly three-quarters of all traumas in this population. Trauma to the thorax represents the second most common site of injury in this population, and is often associated with other serious injuries. Mortality rates are 2–5 times higher in older adults compared to their younger counterparts, often despite equivalent injury severity scores. Risk scoring systems have been developed to identify rib fracture patients at high risk of deterioration. Overall mortality from rib fractures is high, at approximately 10% for all ages. Mortality and morbidity from rib fractures primarily derive from pain-induced hypoventilation, pneumonia and respiratory failure. The main goal of care is therefore to provide sufficient analgesia to allow respiratory rehabilitation and prevent pulmonary complications. The provision of analgesia has evolved to incorporate novel regional anaesthesia techniques into conventional multimodal analgesia. Analgesia algorithms may aid early aggressive management and escalation of pain control. The current role for surgical fixation of rib fractures remains unclear for older adults who have been underrepresented in the research literature. Older adults with rib fractures often have multi-morbidity and frailty which complicate their injuries. Trauma services are evolving, and increasingly geriatricians will be embedded into trauma services to deliver comprehensive geriatric assessment. This review aims to provide an evidence-based overview of the management of rib fractures for the physician treating older patients who have sustained trauma.

We now routinely apply 2 ml local anaesthetic to these branches to accomplish a rapid onset block with demonstrable loss of sensation over the shoulder. We have found that this addition of a supraclavicular block seems highly effective in preventing pain arising from the acromioclavicular joint during shoulder arthroscopy and has the advantage of sparing the other (higher) branches of the superficial cervical plexus. Further investigation is required to clarify these findings.

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Summary Vascular access formation surgery for renal replacement therapy can be performed under local, regional or general anaesthesia. Regional anaesthesia may offer several advantages, however the sensory innervation to the upper medial arm can be difficult to adequately block. We describe a novel regional anaesthetic technique using both supraclavicular brachial plexus and paravertebral blocks for a multimorbid 73‐year‐old woman undergoing brachioaxillary fistula formation with a synthetic graft. An ultrasound‐guided supraclavicular brachial plexus block was performed, followed by an ultrasound‐guided T2/3 level paravertebral block. Adequate sensory blockade for surgery was achieved. Supplemental local anaesthetic infiltration was not required, and the operation was well tolerated by the patient. We consider this to be a valuable regional anaesthetic technique for vascular access formation surgery involving the upper arm.