Should We Utilize Regional Anesthesia for Traumatic Rib Fracture Patients? A TQIP-Based Study

Rib fractures are a common injury in trauma patients and can lead to pneumonia, respiratory failure, and mortality. Multimodal analgesia, alone or with regional anesthetic (epidural or local block), is a mainstay in management. Single-institution studies have evaluated the effectiveness of regional anesthesia with varied results. This study utilized national trauma registry (Trauma Quality Improvement Program [TQIP]) data to evaluate the association between regional anesthesia and mortality, as well as secondary outcomes of hospital complications and ventilator/intensive care unit (ICU)/hospital length of stay (HLOS).

Utilizing TQIP data from 2021, all patients with isolated chest trauma were identified. Data collected included demographic, medical comorbidities, injury severity, type of injury, hospital complications, ventilator/ICU/HLOS, and in-hospital mortality. Patients were categorized as those receiving regional anesthesia (epidural or peripheral nerve block) or no regional anesthesia. Propensity matching was performed, and outcomes were compared.

After propensity matching, 1295 patients were included in each group. There was no significant difference in in-hospital mortality between the two groups. Increased HLOS, ICU admissions, unplanned intubations, and unplanned upgrade to the ICU were associated with regional anesthesia. There were no other significant differences in outcomes between the two groups.

A review of TQIP data did not detect a difference in mortality with regional anesthesia for rib fracture management. Rather, regional anesthesia was associated with increased HLOS, ICU admissions, unplanned intubations, and unplanned upgrade to the ICU. Further study is warranted to assess if subsets of patients might benefit from these procedures.