Patients over the age of 65 years admitted to hospital with more than six rib fractures have a mortality rate as high as 38%. Of the survivors, 34% are likely to be admitted to an aged care facility. High-quality analgesia is paramount to the mitigation of rib fracture–associated morbidity and mortality. We report a series of ten consecutive patients over the age of 65 years with more than eight fractured ribs. All patients were managed with a novel chest wall block. There were no deaths, and only one patient was discharged into an aged care facility.
StawickiSPGrossmanMDHoeyBA, et al.Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc2004; 52(5): 805–808.
2.
WittCEBulgerEM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg acute Care open2017; 2(1): e000064.
3.
CoaryRSkerrittCCareyA, et al.New horizons in rib fracture management in the older adult. Age and Ageing2020; 49(2): 161–167.
4.
BulgerEMEdwardsWTde PintoM, et al.Indications and contraindications for thoracic epidural analgesia in multiply injured patients. Acute Pain2008; 10(1): 15–22.
5.
RileyBMallaUSnelsN, et al.Erector spinae blocks for the management of rib fractures: a pilot matched study. J Clin Anesth2020; 63: 109780.
6.
RileyBMallaUSnelsN, et al.Erector spinae and serratus anterior blocks for the management of rib fractures: a retrospective exploratory matched study. Am J Emerg Med2020; 38: 1689-1691.
7.
JamesMBentleyRGoodmanB. Erector spinae plane vs. paravertebral blockade for rib fracture analgesia. Anaesthesia2019; 74(8): 1064–1065.
8.
BulgerEMArnesonMAMockCN, et al.Rib fractures in the elderly. J Trauma Inj Infect Crit Care2000; 48: 1040–1047.
9.
FokinAWycechJCrawfordM, et al.Quantification of rib fractures by different scoring systems. J Surg Res2018; 229: 1–8.
10.
PeekJSmeeingDPJHietbrinkF, et al.Comparison of analgesic interventions for traumatic rib fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg2019; 45(4): 597–622.
11.
AdhikarySDLiuWMFullerE, et al.The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia2019; 74: 585–593.
IvanusicJKonishiYBarringtonMJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med2018; 43(6): 567–571.
