Identifying the Ideal Rib-Fracture Pain Management Regimen at Discharge - A TQIP Database Review
Carlos G. Chavez, Cecilia Benz, Diana Arellano, Gal Levy.
University of Texas Medical Branch, Galveston, TX, USA.
OBJECTIVE: Due to the prevalence and complications associated with rib fractures, their optimal management has been the focus of increased research. Our study aims to identify a potential best treatment algorithm for discharge pain management in isolated rib fracture patients. METHODS: A retrospective chart review was conducted using the Trauma Quality Improvement Program (TQIP) database. Discharge medication regimen as well as follow-up visit setting, reason, and pain score were documented. Patients were stratified by pain score, visit reasoning, and pain management mechanism defined as a narcotic agent and/or Enhanced Recovery After Surgery (ERAS) medications; consisting of acetaminophen, NSAIDs, muscle relaxers, and/or nerve pain agents. Descriptive statistics were used to quantify the percentage of combinations per follow-up score. RESULTS: The majority of patients with a pain score of 0 were on a narcotic with 3 ERAS medications with no complaints on follow-up.1 The majority of patients with a 1-5 pain score were on a narcotic with 2 ERAS medications with fracture-associated complaints.1 The majority of patients with a 6-10 pain score were on a narcotic with 2 ERAS medications.1 This group had the most patients seen in the ED with fracture-associated complaints and the most treated with ERAS-only medications. CONCLUSIONS: Our observations suggest that neither narcotic nor ERAS medications alone are sufficient pain control methods. The ideal combination seems to be a narcotic agent alongside 3 ERAS medications. This has helped identify a potential best treatment algorithm for the minimization of pain and complication rates in isolated rib fracture patients.
|Pain Severity Groups||Pain Management Regimen at Discharge|
|Pain Severity Score of 0(N=42)||Narcotic Medication Alone||9%||Narcotic + 1 ERAS Medication||2%|
|ERAS Medication(s) Alone||19%||Narcotic + 2 ERAS Medications||29%|
|No Medications||10%||Narcotic + 3 ERAS Medications||31%|
|Narcotic & ERAS Combination||62%||Narcotic + 4 ERAS Medications||0%|
|Pain Severity Score Between 1-5(N=14)||Narcotic Medication Alone||7%||Narcotic + 1 ERAS Medication||14%|
|ERAS Medication(s) Alone||7%||Narcotic + 2 ERAS Medications||50%|
|No Medications||0%||Narcotic + 3 ERAS Medications||21%|
|Narcotic & ERAS Combination||86%||Narcotic + 4 ERAS Medications||0%|
|Pain Severity Score Between 6-10(N=14)||Narcotic Medication Alone||0%||Narcotic + 1 ERAS Medication||7%|
|ERAS Medication(s) Alone||29%||Narcotic + 2 ERAS Medications||36%|
|No Medications||7%||Narcotic + 3 ERAS Medications||14%|
|Narcotic & ERAS Combination||64%||Narcotic + 4 ERAS Medications||7%|
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