Analgesia for rib fractures: a narrative review.

Autor: van Zyl T; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada., Ho AM; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada., Klar G; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada., Haley C; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada., Ho AK; Department of Public Health Sciences (Epidemiology), School of Medicine, Queen's University, Kingston, ON, Canada., Vasily S; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada., Mizubuti GB; Department of Anesthesiology & Perioperative Medicine, Queen's University, Kingston General Hospital, Victory 2 Wing, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. gleniomizubuti@hotmail.com.
Jazyk: angličtina
Zdroj: Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2024 Apr; Vol. 71 (4), pp. 535-547. Date of Electronic Publication: 2024 Mar 08.
DOI: 10.1007/s12630-024-02725-1
Abstrakt: Purpose: Rib fracture(s) is a common and painful injury often associated with significant morbidity (e.g., respiratory complications) and high mortality rates, especially in the elderly. Risk stratification and prompt implementation of analgesic pathways using a multimodal analgesia approach comprise a primary endpoint of care to reduce morbidity and mortality associated with rib fractures. This narrative review aims to describe the most recent evidence and care pathways currently available, including risk stratification tools and pharmacologic and regional analgesic blocks frequently used as part of the broadly recommended multimodal analgesic approach.
Source: Available literature was searched using PubMed and Embase databases for each topic addressed herein and reviewed by content experts.
Principal Findings: Four risk stratification tools were identified, with the Study of the Management of Blunt Chest Wall Trauma score as most predictive. Current evidence on pharmacologic (i.e., acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, lidocaine, and dexmedetomidine) and regional analgesia (i.e., thoracic epidural analgesia, thoracic paravertebral block, erector spinae plane block, and serratus anterior plane block) techniques was reviewed, as was the pathophysiology of rib fracture(s) and its associated complications, including the development of chronic pain and disabilities.
Conclusion: Rib fracture(s) continues to be a serious diagnosis, with high rates of mortality, development of chronic pain, and disability. A multidisciplinary approach to management, combined with appropriate analgesia and adherence to care bundles/protocols, has been shown to decrease morbidity and mortality. Most of the risk-stratifying care pathways identified perform poorly in predicting mortality and complications after rib fracture(s).
(© 2024. Canadian Anesthesiologists' Society.)
Databáze: MEDLINE
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