Investigating pre-hospital and emergency department analgesic management in older adults with confirmed or suspected blunt chest trauma: A systematic review

Background Prompt analgesia for older adults with blunt chest trauma is vital to prevent severe complications associated with pain. Pre-hospital and emergency department (ED) clinicians often have first patient contact but face limited analgesic options. Identifying the most appropriate early analgesia for this high-risk group is crucial to ensure optimal outcomes. Aims This systematic review aimed to describe and compare analgesic strategies used for patients aged 65 years or more in pre-hospital or ED settings, and to explore the potential application of ED findings to pre-hospital care due to a lack of pre-hospital studies. Methods A systematic review of online databases up to July 2025 was conducted using broad search terms and defined inclusion criteria. Narrative synthesis was used for data analysis. Results Seven studies of varied study types and quality were included. No conclusive evidence identified a superior analgesic strategy or a clear impact on clinical outcomes. Nerve blocks provided comparable analgesic relief to epidural analgesia with fewer side effects and the capability of being administered at the bedside by different clinicians. This suggests potential for pre-hospital adaptation. Novel techniques, including cooling spray and percutaneous cryoneurolysis, demonstrated promising results in pain reduction, albeit based on small sample sizes. Secondary outcomes did not differ significantly across studies or analgesic strategies. Conclusions No definitive analgesic strategy was identified. Nerve blocks appear effective with fewer side effects than epidurals, supporting consideration for pre-hospital use. The absence of pre-hospital studies highlights a significant research gap, emphasising the need for future studies to guide prompt and effective analgesia in this population.