Epidural analgesia in patients with traumatic rib fractures: a systematic review of randomised controlled trials

Duch, Patricia; Møller, Morten Hylander

doi:10.1111/aas.12475

Cited by 46 publications

(27 citation statements)

References 33 publications

(68 reference statements)

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“…Previous systematic reviews comparing traditional analgesic modalities have not reported significant differences in mortality or LOS 12 13. Our findings of a reduced rate of critical care LOS in the PA group should be interpreted with caution given the possibility of unmeasured confounding, lack of adjustment for multiple comparisons and secondary outcome metric status.…”

Section: Discussioncontrasting

confidence: 52%

“…The secondary aim was to investigate if there was a difference in patient outcome between the three groups by analyzing the length of stay (LOS) and mortality data. Although systematic reviews have analyzed studies comparing TEA, PA, intercostal nerve blocks and opiate based treatments, to our knowledge, this is the first study to compare the effectiveness of SAP to PA or TEA 12 13…”

Section: Introductionmentioning

confidence: 99%

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Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

Beard

Hillermann

Beard

et al. 2020

Reg Anesth Pain Med

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BackgroundThere is a paucity of data comparing effectiveness of various techniques for pain management of traumatic rib fractures. This study compared the quality of analgesia provided by serratus anterior plane (SAP) catheters against thoracic epidural (TEA) or paravertebral catheters (PA) in patients with multiple traumatic rib fractures (MRFs).Methods354 patients who received either SAP, TEA or PA at two tertiary referral major trauma centers in the UK were included (2016–2018). Primary outcome were change in inspiratory volumes and pain scores. Secondary outcomes included in-hospital mortality, along with the length of stay in hospital and critical care. Data were analyzed using linear, log-binomial and negative binomial regression models.Main resultsAcross all blocks, there was a mean (SD) increase in inspiratory volume postblock of 789.4 mL (479.7). Ninety-eight per cent of all participants reported moderate/severe pain prior to regional analgesia, which was reduced to 34% postblock. There was no significant difference in the change in inspiratory volume or pain scores between the TEA, PA or SAP groups. Overall crude mortality was 13.2% (95% CI 7.8% to 18.7%). In an adjusted analysis and compared with TEA, in-hospital mortality was similar between groups (relative risk (RR) 0.4, 95% CI 0.1 to 1.0) and (RR 0.5, 95% CI 0.2 to 1.6) for SAP and PA, respectively.ConclusionSAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

Beard

Hillermann

Beard

et al. 2020

Reg Anesth Pain Med

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show abstract

“…Controversies exist regarding the best analgesic regimen; comparison studies fail to show clear benefit of regional techniques over other methods (33,34), although more work is needed in this area. Additionally, other injuries and clinical conditions (e.g., spinal injury or coagulopathy) must be taken into account when designing an analgesic regimen.…”

Section: Indications For Surgerymentioning

confidence: 99%

Blunt chest trauma: is there a place for rib stabilization?

Mitchell¹

2017

J. Thorac. Dis.

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“…In contrast, other reviews did not find a difference in mortality, LOHS, or duration of mechanical ventilation. 5,15 But none of these studies looked into significant adverse effects of opioids like delirium.…”

Section: Rib Fracturesmentioning

confidence: 99%