Aims and Objectives Rib fractures account for over 15% of all trauma attendances in the Emergency Department. Among patients with multiple rib fractures, the mortality rate can reach a staggering 33%, and this risk doubles for individuals above the age of 65. Managing pain in these patients is notoriously challenging but essential to prevent complications, facilitate physiotherapy, and improve outcomes. Currently, opioid analgesia remains the primary approach in ED management, despite its association with respiratory depression, nausea, vomiting, and an increased risk of atelectasis. We explore the feasibility of implementing ED-led Thoracic Wall Regional blocks for pain management in patients with multiple rib fractures.

Method and Design To ensure proficiency, ED consultants and ED Registrars underwent bimonthly training in performing the Serratus Anterior Plane Block (SAPB) and the Erector Spinae Plane Block (ESPB). Patients with three or more rib fractures or a BATTLE score > 15 were considered for SAPB or ESPB. These blocks were administered as single-shot injections or through catheter insertion for continuous infusion. We reviewed individual patient notes, collecting data related to the BATTLE score, immediate and delayed complications (bleeding, organ injury, infection, LAST and anaphylaxis), and dynamic pain scores before and after the block. The feasibility of performing these blocks within the ED setting was evaluated based on complications and the necessity for intervention.

Results and Conclusion We conducted 131 blocks, with 80% being single-shot injections and 20% involving catheter insertions. The average BATTLE score in this group was 28.2 (80% probability of complications). Remarkably, no major complications requiring intervention occurred during the study. We did observe nine minor complications, but none of them necessitated any intervention (<1% for single-shot blocks). ED Physicians are already well-versed in the use of ultrasound. Our study demonstrates that ED Physicians can safely administer early SAPB and ESP to patients with multiple rib fractures within the Emergency Department.