EP168 Broken ribs, united approach? A review of rib fracture management across the UK

<h3>Background and Aims</h3> Rib fractures are very common and associated with significant morbidity and mortality. Written and agreed multidisciplinary guidelines should be available as their use improves outcomes for patients (e.g., shorter ITU and hospital stay, decreased incidence of pneumonia and decreased mortality). The guidelines should comprise an agreed analgesia protocol, including indications for neuraxial and regional analgesia. The aim of the study was to analyse UK guidelines for the management of adults with rib fractures with special regard to neuraxial and regional analgesia. <h3>Methods</h3> Guidelines on the clinical management of adults with rib fractures and/or chest wall trauma were requested from every trust in the UK (n=161) via Freedom of Information request. Trusts that do not provide this service, did not reply, provided incomplete information or did not have a guideline in place were excluded. <h3>Results</h3> 11 trusts that provide care for patients with rib fractures did not have a clinical guideline on their management. Of the 120 trusts whose guidelines were reviewed, 96.6% included criteria for use of regional anaesthesia, however 4 trusts did not explicitly recommend regional anaesthesia for rib fractures. 91.6% of trust advocated early use of regional anaesthesia. The most commonly recommend regional technique was a thoracic epidural (78% of trusts), followed by erector spinae plane block +/- catheter (60%), serratus anterior plane block +/- catheter (59%) and paravertebral block +/- catheter (51%). A third of the trusts recommended choosing the block based on location of the fractures. 14% of trusts did not specify the type of regional technique to be used. <h3>Conclusions</h3> There is a significant variation between the trust guidelines on the management of rib fractures across the UK.