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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, Laura Hillermann, Carl Beard, Emma Millerchip, Sue Sachdeva, Rajneesh Gao Smith, Fang
Beard, Laura
Hillermann, Carl
Beard, Emma
Millerchip, Sue
Sachdeva, Rajneesh
Gao Smith, Fang
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2020-03-11
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Abstract
Background There 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). Methods 354 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 results Across 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. Conclusion SAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.
Citation
Beard L, Hillermann C, Beard E, et alMulticenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fracturesRegional Anesthesia & Pain Medicine 2020;45:351-356.
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Research Unit
PubMed ID
32165553 (pubmed)
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Journal article
Language
en
Description
© 2020 The Authors. Published by BMJ Publishing. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1136/rapm-2019-101119
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ISSN
1098-7339
EISSN
1532-8651
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Sponsors
EB is funded by Cancer Research UK. FGS is supported by the National Institute for Health Research (NIHR) Senior Investigator Award. TV is supported by NIHR, CRN Research Scholar and Queen Elizabeth hospital charities.
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Licence for published version: Creative Commons Attribution 4.0 International