Effect of Early Versus Delayed Peripheral Nerve Block Use on Clinical Outcomes in Geriatric Patients with Rib Fractures

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Rib fractures are among the most frequently encountered injuries in geriatric trauma patients and are associated with considerable morbidity and mortality. Pain management is one of the first steps in treatment as uncontrolled pain can lead to significant complications. While systemic opioids were historically used to treat pain in this patient population, their side effects can limit rehabilitation and potentially delay recovery. Newer multimodal pain management regimens, including regional anesthesia, have replaced opioid monotherapy due to improved pain control with fewer side effects.

This study is a single center retrospective chart review done at Corewell Health Butterworth Hospital, which is a level 1 trauma center. Butterworth Hospital has a standard rib fracture protocol used for all patients, which includes multimodal pain management and consultation of anesthesia pain service for possible regional anesthesia intervention. Patients that are placed on continuous peripheral nerve blocks (CPNBs) are normally treated for 5-7 days, including discharge, to assist with continued pain management and prevent readmissions. Ideally, CPNBs are placed within 24 hours of patient arrival to the ED to help manage pain control and decrease complications. However, the benefits of outcomes based on the timing of administration of these agents are unknown. This study aims to show that patients who receive CPNBs at an earlier point in their hospital stay compared to those treated later will have better clinical outcomes.

Patients will be categorized into two groups based on the timing of CPNB initiation: those who received CPNBs within 10 hours of ED arrival, and those who received them between 15- and 24-hour post-arrival. Patients ≥ 65 years old admitted directly to our hospital with ≥ 3 rib fractures and receiving a CPNB will be included. Patients who have GCS ≤ 8 or other traumatic injuries on admission will be excluded. Differences in hospital length of stay, intensive care unit length of stay, hospital mortality, morphine milligram equivalent consumption, and incidence of respiratory failure will be examined and analyzed. Sample t-test, Chi-Square test, or Fisher's Exact test will be used to analyze data. If the data allows, additional analysis techniques such as linear regression or logistic regression may be utilized. A p-value of 0.05 will be used for statistical significance unless multiple comparisons are made at which point the appropriate p-value correction will be performed. Results are currently in process.

This study aims to show that patients who receive CPNBs at an earlier point in their hospital stay compared to those treated later will have better clinical outcomes.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2153

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