Analgesia of Patients with Multiple Rib Fractures in Critical Care: A Survey of Healthcare Professionals in the UK

Abstract

Introduction: Good analgesia has been shown to reduce the risk of pneumonia, chronic pain, and mortality in patients with multiple rib fractures (MRFs). This survey explores the current analgesic practice in the UK, protocol use, barriers to provision, and physician preferences. Materials and methods: A web-based survey was distributed nationally to an enriched cohort of clinicians working in UK trauma units with an interest in MRF management. Results: Seventy-nine healthcare professionals responded. A third (31.4%) reported that their department had a rib fracture pain protocol, 52.9% did not, and 15.7% were unsure. Significantly more respondents reported adequate pain control when a hospital protocol was present compared to when not (χ 2 , p < 0.01). Inadequate analgesia, a poor cough, and inability to breathe deeply were the commonest complications reported by 81.4, 78.6, and 65.7%, respectively. Patient-controlled analgesia (PCA) was the most commonly used form of analgesia (38.6%) followed by thoracic epidural (TEA) (30.0%) and continuous opioid infusion (18.6%). However, TEA was the preferred method of analgesia among respondents (37.1%) followed by serratus block (21.4%), paravertebral block (17.1%), and PCA (14.3%). Discussion: There is considerable variation among physicians in their current use of analgesic modalities, with opiate-based methods predominating despite a physician preference for regional techniques. Thoracic epidurals are preferred by physicians but of limited use as a result of contraindications, time pressures, and staff skill mix. Pain control is reported to be better handled when protocols are present. Further research focusing on currently utilized regional techniques is required in order to produce a validated standardized national protocol that is informed by the current practice, the evidence base, and limitations to service provision.

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“…Effective analgesia balancing early motion and comfort remains a challenge. For trauma procedures, up to 30% of fractures undergo open reduction internal fixation; uncontrolled pain after these surgeries can impede early mobilization and predispose patients to chronic pain [27][28][29][30].…”

Efficacy and safety of ultrasound‐guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial

“…3 When a hospital protocol was present compared to when it was not, considerably more respondents said their pain was adequately controlled. 4 Nonsteroidal anti-inflammatory medications (NSAIDs), codeine, or acetaminophen may be sufficient for milder pain associated with rib fractures. For more severe pain, an opioid with more potency, such as morphine, may be needed.…”

“…As there are no preexisting guidelines for the same nationally, they are often undertreated and pain control in patients is mostly unsatisfactory 3 . When a hospital protocol was present compared to when it was not, considerably more respondents said their pain was adequately controlled 4 . Nonsteroidal anti‐inflammatory medications (NSAIDs), codeine, or acetaminophen may be sufficient for milder pain associated with rib fractures.…”