{
  "abstract": "Background and Aims Blunt chest trauma accounts for ~15% of UK trauma admissions (~5,500 cases/year). Rib fractures carry high morbidity and up to 33% mortality. Regional analgesia can reduce complications in this cohort. Local audit demonstrated underutilisation of regional techniques in rib fracture patients in our trust. We introduced ultrasound-guided continuous erector spinae plane catheters (cESP) in our protocol as an alternative to thoracic epidural for rib fracture pain. This was combined with a departmental education programme. Aims • To assess the effectiveness and feasibility of introducing continuous ESP catheters in managing rib fracture pain • To evaluate patient outcomes under current analgesia practicesMethods This retrospective service evaluation included all adult in-patients admitted with rib fractures over two 3-month cycles. Cycles were before and after introduction of cESPs into our protocol. Ethical approval was waived by the local hospital committee. Patients were identified using the in-house trauma register and data collected from the Electronic Patient Record (EPR). Data included demographics, risk scoring (STUMBL/Battle Score), pain scores, analgesia, regional procedures, complications and admission duration.Results A total of 164 patients were included across two study periods. Numerical pain scores were poorly captured on EPR. Mean Battle scores were similar in both cycles (22.5 pre-cESP, 20.4 post-cESP). cESP introduction resulted in a higher proportion of patients receiving regional intervention for rib fracture pain (22% vs 14%), including patients therapeutically anticoagulated. PCA use was uncommon (11/164). Mean battle score amongst the regional intervention cohort was lower following cESP introduction (30 vs 24). cESP use did not adversely effect length of stay or overall complication rate but infective complications were lower.Conclusions Access to regional techniques improved following cESP introduction including anticoagulated patients previously precluded. Pain score documentation remains inconsistent and requires improvement. Planned future delivery of local anaesthetic via elastometric pumps may improve mobility and length of stay.",
  "authors": [
    {
      "affiliations": [
        "Consultant, Regional Anaesthesia, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK"
      ],
      "name": "Rajesh Shankar"
    },
    {
      "affiliations": [
        "ST6 Anaesthetic Registrar, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK"
      ],
      "name": "Christopher Parnell"
    },
    {
      "affiliations": [
        "Consultant, Regional Anaesthesia, West Hertfordshire Teaching Hospitals NHS Trust, London, UK"
      ],
      "name": "Nilar Myint"
    },
    {
      "affiliations": [
        "ST6 Anaesthetic Registrar, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK"
      ],
      "name": "Shivani Pandya"
    },
    {
      "affiliations": [
        "SAS Dr Anaesthetics, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK"
      ],
      "name": "Vidath Balasooriya"
    },
    {
      "affiliations": [
        "Lead Acute Pain Nurse, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK"
      ],
      "name": "Michelle Ashwell"
    },
    {
      "affiliations": [
        "Acute Pain Nurse, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK"
      ],
      "name": "Tracey Robertson"
    },
    {
      "affiliations": [
        "Acute Pain Nurse, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK"
      ],
      "name": "Camilla Zorloni"
    }
  ],
  "title": "OP51 Continuous erector spinae catheter for rib fracture analgesia – QI project",
  "uid": "99ceffb7-57a6-5071-9915-561bfa6d37f4"
}