Effect of Regional Anesthesia Timing on Association with Delirium among Geriatric Trauma Patients with Multiple Rib Fractures

Abstract

INTRODUCTION: Rib fractures cause significant morbidity among geriatric trauma patients, and elderly patients are at increased risk for delirium. Regional anesthesia (RA) has been shown to reduce the need for deliriogenic pain medications. We hypothesized that early use of RA may be associated with decreased delirium among this patient population. METHODS: We performed a retrospective review at our Level I trauma center to identify patients with 2 or more rib fractures from 2018 to 2019. We collected demographics, regional anesthesia type/timing, and outcomes including all Confusion Assessment Method (CAM) assessments recorded for each patient throughout their hospitalization. We calculated percentage of CAM negativity for each hospitalization (percentage of CAM negativity = negative CAM assessments/total CAM assessments × 100). RESULTS: A total of 636 patients with more than 1 rib fracture were identified. A total of 323 patients were older than 60 years. A total of 81 (25.1%) underwent RA (46 epidurals, 26 erector spinae blocks, 7 serratus anterior blocks, and 2 paravertebral blocks), and 242 (74.9%) did not receive RA. Mean percentage of CAM negativity was higher among RA patients than non-RA patients (95.1% vs 91.3%, p = 0.04); however, subgroup analysis showed patients receiving RA after 36 hours of admission had no difference in percentage of CAM negativity compared with non-RA patients (90.2% vs 91.3%, p = 0.78; Figure). Timing of RA did not affect in-hospital mortality, overall length of stay, ICU length of stay, or ventilator days.Figure.: CAM, Confusion Assessment Method.CONCLUSION: Among elderly trauma patients with multiple rib fractures, regional anesthesia use is associated with decreased rates of delirium; however, this effect is lost when RA is initiated more than 36 hours after admission.