Editing Rib fractures (section)

== Analgaesia ==

* Standard regime from RMH: paracetamol, regular NSAID/COX2 inhibitor, PRN oxycodone (+/- gabapentin and tramadol)
* Step up to PCA +/- nerve block +/- ketamine (low-dose 1-3mcg/kg/min)
* Epidural anaesthesia was standard of care in bilateral rib fractures for a long time, but does cause hypotension, tethers the patient, >10% failure rate, epidural haematoma or infection, and spinal cord injury. Large matched analysis suggested no mortality benefit and increased respiratory complications. Should not be used with suspected abdominal injuries. Other relative contraindications: spinal fractures, history of spinal surgery, valvular heart disease, coagulopathy
* Serratus anterior block best for anterior fractures
* Erector spinae block - easy to place, good for posterior, lateral and anterior fractures, variable sensory block