APS – Rib Fracture Analgesia
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Analgesia considered sufficient if:
•
Can deep breathe
•
Can cough (with towel splint support prn)
•
Can gently move around the bed
Patient referred to APS
(high risk or deteriorating low risk)
Pain registrar review within 2 hours unless other
emergency prevents this (consider colleague’s help)
Optimise analgesia – check prescribed & given:
•
Regular paracetamol
•
Regular celebrex
•
Regular tramadol
•
Hourly opioid prn – enough given?
Oral analgesia
optimised?
No
Review within 4 hours
Yes
Yes
Yes
Review within 4 hours
Yes
Set up ketamine infusion
Ensure Acute Pain Service notified
Book patient into Level 8 PACU or acute theatre as
URGENT case and perform block
Ensure Acute Pain Service notified
Call Level 8 senior on call
anaesthetist for further advice
No
Would ketamine help?
No
Can you or another anaesthetist
on site perform the block?
Thoracic epidural
OR
Bilateral erector spinae blocks
(with catheter insertion)
Coagulation normal?
Yes
Bilateral erector spinae blocks
(with catheter insertion)
No
Yes
Unilateral fractures?
Unilateral erector
spinae block
(with catheter insertion)
No
IV opioids effective?
Consider PCA
Review within 4 hours
Needs regional analgesia
No
Analgesia sufficient?
Ensure Acute Pain Service
notified
Analgesia sufficient?
No
No Improvement
Regional required
No
Yes
Yes