Regional anesthesia modalities in blunt thoracic trauma: A systematic review and Bayesian network meta-analysis

Abstract

Background: Various regional anesthesia techniques have been studied for blunt chest wall trauma over the past decades, but their impact on patient outcomes remains unclear. This systematic review and Bayesian network meta-analysis aimed to identify the most effective regional anesthesia techniques for different outcomes in blunt thoracic trauma patients.

Methods: We searched Medline, EMBASE, Scopus, and Cochrane databases for randomized controlled trials comparing regional anesthesia techniques (thoracic epidural, erector spinae plane block, serratus anterior plane block, intercostal block, paravertebral block, intrapleural block, retrolaminar block) and standard intravenous analgesia. Eligible studies reported at least one of the following outcomes: pain control, ICU and hospital length of stay, mechanical ventilation duration, pneumonia incidence, and additional analgesic use. Bayesian network meta-analysis models were created for each outcome, and confidence in results was assessed using the CINeMA framework.

Results: We included 27 randomized controlled trials with 1586 patients. Thoracic epidural consistently showed efficacy in reducing pain at 24 h, mechanical ventilation duration, and ICU and hospital stays. The erector spinae plane block also reduced pain and hospital stay. Confidence in these results was low to moderate, primarily due to imprecision.

Conclusions: Various locoregional techniques are being investigated for managing pain in blunt thoracic trauma, with thoracic epidural showing consistent positive effects on pain and other key outcomes. Fascial blocks are emerging as potential alternatives with similar pain relief, though evidence on other outcomes is limited. Future studies should compare the efficacy of these techniques on more definitive endpoints.

Keywords: Analgesia; Complications; Drug therapy; Epidural; Etiology; Methods; Nerve block; Pain; Pneumonia; Randomized controlled trials as topic; Rib fractures.