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Safety, complications and clinical outcome after ultrasound‐guided paravertebral catheter insertion for rib fracture analgesia: a single‐centre retrospective observational study

Lookup NU author(s): Dr Ben Goodman

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Abstract

© 2019 Association of Anaesthetists Rib fractures are associated with significant morbidity and mortality. Ultrasound-guided thoracic paravertebral catheter insertion has been described for the management of pain secondary to rib fractures. We conducted a retrospective observational study of all patients with rib fractures who had a paravertebral catheter inserted for analgesia provision over a 4-year period. Data from the Trauma Audit and Research Network were used to compare patients with rib fractures who were managed with paravertebral catheters to those managed with systemic analgesia. A total of 314 consecutive paravertebral catheters were inserted in 290 patients. Five (1.9%) catheters were removed due to ineffective analgesia. Other minor complications occurred in three cases (0.96%). The proportion of rib fracture patients managed with paravertebral catheters increased from 31/200 (15.5%) in the first year of study to 81/168 (48.2%) in the fourth; over this time-period the observed:predicted mortality ratio fell from 1.04 to 0.66. Proportional hazard regression with and without propensity score matching demonstrated a reduction in mortality associated with paravertebral catheter use, but this became statistically non-significant when time-dependent analysis was used. Paravertebral catheters are a safe and effective technique for rib fracture analgesia; however, our data were insufficient to demonstrate any improvement in mortality.

Publication metadata

Author(s): Womack J, Pearson JD, Walker IA, Stephens NM, Goodman BA

Publication type: Article

Publication status: Published

Journal: Anaesthesia

Year: 2019

Volume: 74

Issue: 5

Pages: 594-601

Print publication date: 01/05/2019

Online publication date: 27/01/2019

Acceptance date: 19/12/2018

ISSN (print): 0003-2409

ISSN (electronic): 1365-2044

Publisher: Blackwell Publishing Ltd

URL: https://doi.org/10.1111/anae.14580

DOI: 10.1111/anae.14580

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