B68 Establishing a regional nerve block pathway for patients presenting with rib fractures at a trauma unit in London

Abstract

<h3>Background and Aims</h3> Rib fractures are a common injury following blunt chest wall trauma¹, leading to significant morbidity and mortality². Effective patient analgesia is pivotal. Guidelines advise multimodal analgesia, including thoracic epidural analgesia (TEA) or regional nerve blocks such as serratus anterior (SA) or erector spinae plane (ESP) blocks³. Our hospital is a trauma unit in North East London. We developed a standard operating procedure and training to provide SA and ESP blocks for our patients with rib fractures. Our aim was to audit the effectiveness of these blocks in patients with rib fractures. <h3>Methods</h3> Patients presenting with rib fractures (between May and December 2021) were assessed pre and post regional block. Pain was evaluated at rest and on movement using the Visual Analogue Scale (VAS). Patients were also judged for their ability to cough and deep breathe. <h3>Results</h3> 9 patients had regional blocks performed. 7 patients had a SA block (one with bilateral blocks) and 2 patients had an ESP block. Mean VAS scores were significantly reduced following regional block from 6.1 to 1.3 at rest (p&lt; 0.001) and 8.6 to 4.8 on movement (p&lt;0.0001). The number of patients able to deep breathe increased from 1 to 8 and the number of patients able to cough increased from 0 to 7 following regional block. No complications were observed in any patients. <h3>Conclusions</h3> This audit data demonstrates that introducing a regional block service for rib fracture patients in a district general hospital is a potentially safe and effective method at reducing pain and improving pulmonary function.