Use of Continuous Regional Anesthesia Infusion as an Opioid-Sparing Modality in Mechanically Ventilated Patients With...

Continuous regional anesthesia (CRA) techniques are used for analgesia in patients with acute rib fractures. However, there is a paucity of evidence supporting the initiation of CRA in patients receiving mechanical ventilation (MV). We therefore performed this retrospective study to assess changes in opioid consumption and the rate of liberation from MV in patients with traumatic rib fractures.

Patients referred to the Acute Pain Service (January 2022-July 2023) who were mechanically ventilated with acute rib fractures were included in this study. Patients received consultation either with or without CRA. Demographic and severity of injury data were collected. Mechanical ventilator requirements, pain scores, sedation use, opioids, adjunct analgesics, neurological status, and sedation status were collected for the 24 h prior to APS consultation/CRA intervention and for 48 h afterward.

Forty patients were included in the study, with 18 in the non-CRA group and 22 in the CRA group. There was a statistically significant decrease in overall opioid consumption (oral morphine equivalents) for the CRA group compared to the non-CRA group 0-48 h postintervention (0-24 h post-CRA [median 135 mg { 33.1-296.6}]) versus non-CRA 368.3 (121.5-727.9) (p = 0.018), 24-48 h post-CRA (31.5 mg [11.5-131.6] vs. non-CRA 342.8 [99.3-645.8]) (p = 0.001). There was no significant difference in rates of liberation from MV between groups.

CRA use was associated with a decrease in opioid consumption 24-48 h after CRA intervention compared to baseline. CRA did not facilitate early liberation from MV.

This retrospective study provides evidence that CRA may reduce opioid requirements in mechanically ventilated patients with rib fractures. Although CRA did not facilitate earlier liberation from ventilation, the opioid-sparing effect is clinically relevant in this population. Larger prospective studies are warranted to define optimal timing, patient selection, and integration of CRA into critical care pathways.