Regional anaesthesia techniques for management of severe chest wall trauma: a major trauma centre retrospective observational study

Purpose Chest wall trauma involving rib fractures represents an anaesthetic challenge, often resulting in high opioid requirements, hypoventilation, hypostatic pneumonia and respiratory failure. Regional anaesthesia (RA) techniques have the potential to reduce opioid consumption and maintain oxygenation. In this study we characterise a cohort of trauma patients who have received RA blocks and assess the impact of such techniques on respiratory support requirements, opioid consumption and outcomes. Methods We retrospectively collected data from all patients with chest wall trauma who received RA techniques with catheter placement from October 2018 to August 2022. Results Data from 187 patients was reviewed. Mean age was 64.25 years, median injury burden was 7 rib fractures and mean STUMBL score was 33.4. Erector Spinae Plane block (n = 131, 70.1%) and Serratus Anterior Plane block (n = 43, 23%) were the most used techniques. Thirty patients (16%) underwent rib fixation. RA significantly reduced the highest respiratory support requirements 24 h post-RA compared to 24 h pre-RA (p = 0.001) and lowest recorded peripheral oxygen saturations also significantly improved (91.5% pre-RA vs. 92.9% post-RA, p < 0.001). Opioid consumption significantly reduced 24 h post-RA compared to 24 h pre-RA (20.5 mg vs. 14 mg of intravenous morphine equivalents, p < 0.001). One hundred and forty-nine (79.7%) patients required ICU admission and 168 (89.8%) survived to hospital discharge. Conclusion Our analysis demonstrated improvement in respiratory support and reduction in opioid consumption following RA techniques in a high injury burden patient cohort. These results support RA utilisation in patients with significant chest wall trauma, especially if rib fixation is not immediately available.