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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.

Table 1: Pain Severity Score Groups with Associated Patient Populations and Pain Management Regimen
Pain Severity GroupsPain Management Regimen at Discharge
Pain Severity Score of 0(N=42)Narcotic Medication Alone9%Narcotic + 1 ERAS Medication2%
ERAS Medication(s) Alone19%Narcotic + 2 ERAS Medications29%
No Medications 10%Narcotic + 3 ERAS Medications31%
Narcotic & ERAS Combination62%Narcotic + 4 ERAS Medications0%
Pain Severity Score Between 1-5(N=14)Narcotic Medication Alone7%Narcotic + 1 ERAS Medication14%
ERAS Medication(s) Alone7%Narcotic + 2 ERAS Medications50%
No Medications0%Narcotic + 3 ERAS Medications21%
Narcotic & ERAS Combination86%Narcotic + 4 ERAS Medications0%
Pain Severity Score Between 6-10(N=14)Narcotic Medication Alone0%Narcotic + 1 ERAS Medication7%
ERAS Medication(s) Alone29%Narcotic + 2 ERAS Medications36%
No Medications7%Narcotic + 3 ERAS Medications14%
Narcotic & ERAS Combination64%Narcotic + 4 ERAS Medications7%


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