Feasibility and Impact of Out-of-Theatre Regional Anesthesia for Rib Fractures: A Retrospective Cohort Study.

Introduction Rib fractures cause significant morbidity due to pain-induced respiratory issues. While regional anesthesia (RA) provides excellent pain relief, evidence for its administration outside of theatres remains limited. This study aimed to evaluate the feasibility and clinical impact of out-of-theatre RA for traumatic rib fractures. Methods A retrospective cohort study was conducted at a district general hospital and regional trauma unit between January 2021 and December 2023. The primary outcomes were the feasibility and complications of RA. Secondary outcomes were mortality and length of stay (LOS). Results A total of 848 records were screened, and 682 patients met the inclusion criteria. Within this cohort, 126 received RA combined with systemic analgesia, while 556 received systemic analgesia alone. Out-of-theatre administration of RA was performed in 18.4% of patients, with the most common technique being the erector spinae plane block (ESPB). The majority of the blocks (83%) were performed by anesthetists. Complications included 26 (21%) instances of catheter dislodgement, 8 (16%) block failures, and one (1%) catheter infection. Overall mortality was 10%, with 10.4% in the systemic analgesia-only group and 7.9% in the RA with systemic analgesia group. The unadjusted OR for mortality with RA was 0.74 (95% CI, 0.36-1.49; p=0.4), and the adjusted OR was 0.85 (95% CI, 0.42-1.71; p=0.66), with neither reaching statistical significance. Median LOS was significantly longer in the RA group than in the systemic analgesia-only group: 9 days (IQR, 6-14) vs 6 days (IQR, 3-12), respectively (p<0.001), and remained so after adjustment. Conclusion Out-of-theatre RA for rib fractures may be feasible, with relatively few reported complications in our cohort. RA was delivered using fascial plane blocks. However, it was not possible to associate the use of RA with mortality or LOS due to the limitations of this study.