Pain management for hospitalized patients with rib fractures: A systematic review of randomized clinical trials

Fadi Hammal; Christine Chiu; Janice Y Kung; Nori Bradley; Derek Dillane

doi:10.1016/j.jclinane.2023.111276

Pain management for hospitalized patients with rib fractures: A systematic review of randomized clinical trials

J Clin Anesth. 2024 Feb:92:111276. doi: 10.1016/j.jclinane.2023.111276. Epub 2023 Oct 24.

Authors

Fadi Hammal¹, Christine Chiu¹, Janice Y Kung², Nori Bradley³, Derek Dillane⁴

Affiliations

¹ Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada.
² John W. Scott Health Sciences Library, University of Alberta Hospital, Edmonton, AB, Canada.
³ Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada.
⁴ Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada. Electronic address: dillane@ualberta.ca.

PMID: 37883901
DOI: 10.1016/j.jclinane.2023.111276

Abstract

Study objective: Rib fractures (RF) are common injuries. Multiple analgesia strategies are available for treatment of pain associated with RF. However, the optimal multimodal technique for pain management is not known. The primary aim of this review was to evaluate the status of evidence derived from randomized clinical trials (RCTs) on the effectiveness of pain management modalities for rib fracture pain. Other patient-centered outcomes were secondary objectives.

Methods: Searches were conducted in MEDLINE, Embase, Scopus, and Cochrane Library. The screening process involved two phases, two researchers independently screened the title and abstract and subsequently screened full text. RCT data were extracted independently by two research team members. Consensus was achieved by comparison and discussion when needed. Risk of bias assessment was performed using the Cochrane Risk of Bias 2 tool.

Results: A total of 1344 citations were identified. Title and abstract screening excluded 1128 citations, and full text review excluded 177 articles. A total of 32 RCTs were included in the full review. Multiple analgesia techniques and medications were identified and their effect on pain score and need for rescue opioid analgesia. None of the included studies were judged to have a high risk of bias, while only 10 studies were assessed as having a low risk of bias.

Conclusions: This systematic review found that studies are of low quality with diverse methodologies and outcomes. A reduction in pain scores was found for epidural analgesia when compared with other modalities. However, the low quality of the evidence necessitates cautious interpretation of this finding. PROSPERO registration: CRD42022376298 (Nov, 16, 2022).

Keywords: Pain management; Regional anesthesia; Rib fractures; Systematic review.

Publication types

Systematic Review
Review

MeSH terms

Analgesia, Epidural*
Humans
Pain
Pain Management
Randomized Controlled Trials as Topic
Rib Fractures* / complications
Rib Fractures* / therapy