Comparison of analgesic interventions for traumatic rib fractures: a systematic review and meta-analysis

Jesse Peek, Diederik P J Smeeing, Falco Hietbrink, Roderick M Houwert, Marije Marsman, Mirjam B de Jong, Jesse Peek, Diederik P J Smeeing, Falco Hietbrink, Roderick M Houwert, Marije Marsman, Mirjam B de Jong

Abstract

Purpose: Many studies report on outcomes of analgesic therapy for (suspected) traumatic rib fractures. However, the literature is inconclusive and diverse regarding the management of pain and its effect on pain relief and associated complications. This systematic review and meta-analysis summarizes and compares reduction of pain for the different treatment modalities and as secondary outcome mortality during hospitalization, length of mechanical ventilation, length of hospital stay, length of intensive care unit stay (ICU) and complications such as respiratory, cardiovascular, and/or analgesia-related complications, for four different types of analgesic therapy: epidural analgesia, intravenous analgesia, paravertebral blocks and intercostal blocks.

Methods: PubMed, EMBASE and CENTRAL databases were searched to identify comparative studies investigating epidural, intravenous, paravertebral and intercostal interventions for traumatic rib fractures, without restriction for study type. The search strategy included keywords and MeSH or Emtree terms relating blunt chest trauma (including rib fractures), analgesic interventions, pain management and complications.

Results: A total of 19 papers met our inclusion criteria and were finally included in this systematic review. Significant differences were found in favor of epidural analgesia for the reduction of pain. No significant differences were observed between epidural analgesia, intravenous analgesia, paravertebral blocks and intercostal blocks, for the secondary outcomes.

Conclusions: Results of this study show that epidural analgesia provides better pain relief than the other modalities. No differences were observed for secondary endpoints like length of ICU stay, length of mechanical ventilation or pulmonary complications. However, the quality of the available evidence is low, and therefore, preclude strong recommendations.

Keywords: Analgesia; Anesthesia; Hospitalization; Mortality; Pain Management; Rib Fractures.

Conflict of interest statement

The authors declared no conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram representing the search and screen process of articles describing analgesic interventions in patients with traumatic rib fractures
Fig. 2
Fig. 2
Forest plot of the length of a hospital stay b intensive care unit stay c mechanical ventilation (epidural vs intravenous). d forest plot of the pulmonary complications (epidural vs intravenous)
Fig. 2
Fig. 2
Forest plot of the length of a hospital stay b intensive care unit stay c mechanical ventilation (epidural vs intravenous). d forest plot of the pulmonary complications (epidural vs intravenous)
Fig. 3
Fig. 3
Forest plot of the length of a hospital stay b intensive care unit stay (epidural vs intercostal)
Fig. 4
Fig. 4
Forest plot of the length of a hospital stay b intensive care unit stay (epidural vs paravertebral)

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