How Timing of Regional Anesthesia Impacts Outcomes in Traumatic Rib Fracture Patients: A Trauma Quality National...

Rib fractures are a common traumatic injury with significant morbidity and mortality. Management requires adequate pain control, often requiring the addition of regional anesthesia (RA), such as peripheral nerve blocks or epidural placement. There is a paucity of data evaluating the optimal timing of RA, which this study aims to address utilizing the national trauma registry (Trauma Quality National Improvement Program) data.

Trauma Quality National Improvement Program data from 2021 for patients with isolated chest trauma were obtained. RA data were obtained using International Classification of Disease-10 codes. Demographics, medical comorbidities, injury severity, hospital complications, ventilator days, intensive care unit (ICU) days, hospital length of stay (HLOS), and in-hospital mortality data were collected. Patients were categorized as those receiving RA < 4-h, <12-h, <24-h, and >24-h from admission. Nearest neighbor matching was performed. Complications and in-hospital outcomes were compared between those receiving RA before and after the specified time frame. Numerical variables were examined with median two-sample tests. Categorical variables were examined by Fisher exact test.

Eighty-seven patients received RA within 4 h, 327 within 12 h and 552 within 24 h. Patients who received RA within 4 h had decreased hospital LOS compared to those >4 h (5 versus 7 d, P = 0.0102). This result was again demonstrated in the <12 and <24 h groups relative to their comparison groups; however, the difference in HLOS was most pronounced in the <4 h group. Furthermore, greater than 24 h to RA demonstrated 2.5x more unplanned ICU admissions (P = 0.0046).

Administration of RA within 24 h of presentation is associated with fewer ICU admissions. Furthermore, earlier administration of RA is associated with decreased HLOS with greatest benefit demonstrated at < 4 h from admission. Providing RA within 4 h can prove logistically difficult in the clinical setting. The fewest number of patients in our analysis fell within this timeframe, suggesting a need for earlier recognition of patients needing RA or more streamlined access to RA within hospital systems. Nevertheless, unplanned ICU admissions remained unaffected within 24 h to RA from admission, suggesting a more feasible clinical target.