Acute Traumatic Rib Fracture Pain Trajectories: An Observational Study

Introduction

Rib fractures occurring from trauma have been associated with increased morbidity and mortality. The Eastern Association for the Surgery of Trauma previously recommended the use of regional anesthesia to treat acute rib fracture pain based on studies of thoracotomy patients1. However, recently the recommendations were changed based on rib fracture literature whose statistical methods are limited to retrospective studies assessing total body pain scores in patients with multiple sources of pain2. We aimed to describe the pattern of acute pain regression in patients with acute rib fractures as well as to elucidate which fracture patterns or patient characteristics are associated with more severe pain. We will identify pain trajectories for acute rib fracture pain by prospectively collecting site-specific pain scores in polytrauma patients. The goal of identifying pain trajectories is to tailor the use and duration of multimodal analgesic regimens perioperatively as well as opioid weaning strategies to the specific procedure. To date, there is no acute pain trajectory for rib fractures.  We hypothesized the pain trajectories will follow 3 different patterns (mild, moderate and severe pain) depending on the number, location and severity of the rib fractures, the presence of a flail segment and thoracostomy tubes, as well surgical management and indwelling pain catheters.