Examining Canadian Trauma Centres' Analgesic Protocols for Rib Fractures

Rib fractures are common in patients with blunt thoracic trauma, and their associated pain causes significant morbidity and mortality. Adequate analgesia is crucial to prevent rib fracture-associated pulmonary complications. However, current analgesic modalities have drawbacks, and the optimal analgesia protocol remains elusive. Intravenous (IV) lidocaine infusions have a well-established safety profile and efficacy in other patient populations and may benefit patients with traumatic rib fractures. To better understand current practices and to inform the design of a multi-centre trial, we believe that a study to determine Canadian trauma centres' current analgesic practices is warranted. This study describes the current familiarity and use of IV lidocaine infusions for management of rib fracture pain. Secondary outcomes included the identification of common Canadian analgesic protocols for rib fractures and willingness to participate in a future multi-centre trial of lidocaine for these traumatic injuries.

We distributed an online survey to 14 Canadian trauma centres. Study questions were designed to address four themes: trauma centre characteristics; pain management strategies; current use of IV lidocaine infusions; and interest in future study participation. The analysis included a frequencies analysis and a thematic analysis of descriptions.

The medical directors of 12 trauma centres (85%) responded. Six of those centres (50%) experience > 450 annual trauma admissions with Injury Severity Scores > 12. Six sites (50% of respondents) have a rib-fracture analgesic protocol. Four centres (33% of respondents) frequently use IV lidocaine for rib fractures, and 10 (83% of respondents) believe further research with IV lidocaine is needed.

Canadian trauma centres' current practices for rib-fracture pain management are variable. Prospective work is needed to evaluate IV lidocaine as an analgesic for traumatic rib fractures.