The effect of fascial block on opioid consumption in patients with multiple rib fractures: a retrospective observational study

Pain is a common feature in multiple rib fractures. Opioids are the mainstay of analgesic therapy due to their high efficacy, however, can lead to a reduction in respiratory rate and tidal volume, sedation and respiratory failure. Fascial blocks can provide safe, adequate analgesia with only local effects. This study aims to investigate the effect of fascial block on the reduction of total opioid consumption. A retrospective observational study, conducted in the emergency medicine unit (EMU), including all adult, opioid-naïve patients admitted between January 2022 and August 2024 with post-traumatic blunt chest trauma. 103 patients, 26 (27.9%) women, with a median age of 62 years (IQR 56-76), a median Thoracic Trauma Severity Score (TTSS) of 8 (IQR 7-9), a median pain score of 8 on the 0-10 Numeric ranking scale, and 66 patients (60.2%) underwent fascial block. Median total opioid consumption was 92 morphine milligram equivalents (IQR 61.5-140), significantly lower in patients undergoing fascial block (71 (IQR 60-101) vs. 150 (110-210), p < 0.001), despite higher pain on admission (8 (IQR 7-9) vs. 6 (IQR 5-7), p < 0.01), with better pain control and no differences in total length of stay, TTSS or number of rib fractures. This study shows that fascial blocks in patients admitted to the EMU for post-traumatic pain due to multiple rib fractures are associated with a significant reduction in overall opioid consumption and no specific complication, supporting the use of a multimodal approach for better pain control.