Article Figures & Data
Figures
- Figure 1
CONSORT diagram for patient selection. CONSORT, Consolidated Standards of Reporting Trials.
Tables
- Table 1
Characteristics of ON-Q analgesia catheter use
Mean±SD Length of use (days) 4.5±4.10 Number of ribs anesthetized 8.0±3.26 Initial rate of 0.2% ropivacaine infusion (cc/hour) 11.1±3.62 Length of ICU admission prior to catheter insertion (days) 2.3±2.03 Length of ICU stay after catheter insertion (days) 6.6±5.50 Length of mechanical ventilation prior to catheter insertion (days) 1.5±2.09 Length of mechanical ventilation after catheter insertion (days) 1.5±2.44 ICU, intensive care unit.
- Table 2
Comparison of demographic and injury characteristics in patients with multiple rib fractures based on use of ON-Q catheter for continuous intercostal nerve blockade
ON-Q catheter (CATH)
(n=48)No ON-Q catheter (STD)
(n=96)P value Demographics Mean age (years) 56.8±18.30 56.4±18.72 0.91 Gender (%) Male 31 (64.6) 69 (71.9) 0.37 Female 17 (35.4) 27 (28.1) Mechanism of injury (%) Blunt 46 (95.8) 93 (96.9) 0.75 Penetrating 2 (4.2) 3 (3.1) Injury characteristics Injury Severity Score 24.9±9.81 24.7±9.73 0.93 Abbreviated Injury Scale score area Head 1.2±1.34 1.8±1.61 0.02 Head >3 (%) 4 (8.3) 16 (16.7) 0.14 Neck 2.9±0.88 2.8±0.83 0.72 Thorax 1.5±1.73 1.6±1.76 0.62 Abdomen 1.5±1.11 1.4±1.33 0.82 Number of rib fractures 9.3±3.73 6.60±4.11 0.001 Anterior 3.6±4.42 2.9±3.95 0.32 Lateral 3.2±4.16 1.3±2.20 0.004 Posterior 3.9±3.44 2.9±3.44 0.06 Six or more rib fractures (%) 39 (81.3) 44 (48.9) <0.001 Number of flail segments 2.0±2.94 0.8±1.76 0.02 Three or more flail segments (%) 15 (31.3) 16 (19.8) 0.14 Bilateral rib fractures (%) 15 (31.3) 46 (47.9) 0.06 Tube thoracostomy (%) 34 (70.8) 37 (38.5) <0.001 Thoracotomy (%) 3 (6.3) 5 (5.2) 0.80 Video Assisted Thorascopic Surgery (VATS) (%) 2 (4.2) 5 (5.2) 0.78 Rib fixation (%) 10 (20.8) 3 (3.1) <0.001 Laparotomy (%) 5 (10.4) 15 (15.6) 0.39 Results shown as mean±SD unless otherwise noted.
Estimates from Pearson’s χ2 and independent t-test for categorical and continuous variables, respectively.
CATH, patients with multiple rib fractures managed with continuous intercostal nerve blockade; STD, patients with multiple rib fractures managed without continuous intercostal nerve blockade.
- Table 3
Comparison of outcomes in patients with multiple rib fractures based on use of ON-Q catheter for continuous intercostal nerve blockade
ON-Q catheter (CATH)
(n=48)No ON-Q catheter (STD)
(n=96)P value Outcomes 30-day hospital-free days 15.9±6.43 13.2±9.94 0.048 90-day hospital-free days 74.7±12.53 63.3±28.12 0.001 ICU-free days 4.9±3.71 6.0±5.65 0.18 Ventilator-free days 9.4±4.57 9.8±8.15 0.68 Unplanned intubation (%) 2 (4.2) 6 (6.3) 0.61 Failed extubation (%) 4 (8.3) 10 (10.4) 0.69 Required tracheostomy (%) 4 (8.3) 17 (17.7) 0.13 Pneumonia (%) 2 (4.2) 16 (16.7) 0.03 Hospital mortality (%) 1 (2.1) 13 (13.5) 0.03 Cardiopulmonary (%) 1 (2.1) 7 (7.3) 0.11 Rib fracture complication* (%) 8 (16.7) 33 (34.4) 0.03 Results shown as mean±SD unless otherwise noted.
Estimates from Pearson’s χ2 and independent t-test for categorical and continuous variables, respectively.
*Either unplanned intubation, failed extubation, pneumonia, tracheostomy requirement, or hospital mortality.
CATH, patients with multiple rib fractures managed with continuous intercostal nerve blockade; ICU, intensive care unit; STD, patients with multiple rib fractures managed without continuous intercostal nerve blockade.
- Table 4
Comparison of patients with multiple rib fractures based on management with standard medical management, rib fixation, or ON-Q catheter for continuous intercostal nerve blockade
ON-Q catheter without rib fixation
(n=38)Rib fixation
(n=13)Standard medical management
(n=93)P value Age 56.0±18.94 54.9±17.24 56.9±18.69 0.92 Number of rib fractures 9.0±3.78 11.2±3.14 6.4±4.00* <0.001 Number of flail segments 1.2±2.25 4.5±3.28* 0.8±1.69 <0.001 30-day hospital-free days 16.7±6.51 11.5±7.15 13.4±9.89 0.09 90-day hospital-free days 75.1±13.83 70.2±9.94 63.4±28.46 0.04 ICU-free days 4.7±3.83 5.6±3.62 6.0±5.69 0.44 Ventilator-free days 8.9±4.34 11.5±5.13 9.7±8.22 0.51 Unplanned intubation (%) 2 (5.3) 0 6 (6.5) 0.63 Failed extubation (%) 3 (7.9) 3 (23.1) 8 (8.6) 0.23 Required tracheostomy (%) 2 (5.3) 3 (23.1) 16 (17.2) 0.14 Pneumonia (%) 2 (5.3) 1 (7.7) 15 (16.1) 0.20 Hospital mortality (%) 1 (2.6) 0 13 (14.0) 0.06 Rib fracture complication† (%) 6 (15.8) 5 (38.5) 30 (32.3) 0.12 Results shown as mean±SD unless otherwise noted.
Estimates from Pearson’s χ2 and analysis of variance for categorical and continuous variables, respectively.
*P≤0.05.
†Either unplanned intubation, failed extubation, pneumonia, tracheostomy requirement, or hospital mortality.
ICU, intensive care unit.
- Table 5
Comparison of outcomes in patients with multiple rib fractures based on use of ON-Q catheter for continuous intercostal nerve blockade, excluding patients with rib fixation
ON-Q catheter (CATH)
(n=38)No ON-Q catheter (STD)
(n=76)P value Outcomes 30-day hospital-free days 16.7±6.51 12.2±10.05 0.005 90-day hospital-free days 75.1±13.83 60.8±29.47 0.001 ICU-free days 4.7±3.83 6.3±6.09 0.09 Ventilator-free days 8.9±4.33 10.2±8.79 0.29 Unplanned intubation (%) 2 (5.3) 6 (7.9) 0.72 Failed extubation (%) 3 (7.9) 8 (10.5) 0.75 Required tracheostomy (%) 2 (5.3) 15 (19.7) 0.04 Pneumonia (%) 2 (5.3) 14 (18.4) 0.06 Hospital mortality (%) 1 (2.6) 12 (15.8) 0.04 Rib fracture complication* (%) 6 (15.8) 28 (36.8) 0.02 Results shown as mean±SD unless otherwise noted.
Estimates from Pearson’s χ2 and independent t-test for categorical and continuous variables, respectively.
*Either unplanned intubation, failed extubation, pneumonia, tracheostomy requirement, or hospital mortality.
CATH, patients with multiple rib fractures managed with continuous intercostal nerve blockade; ICU, intensive care unit; STD, patients with multiple rib fractures managed without continuous intercostal nerve blockade.
- Table 6
Comparison of opioid analgesic requirements in patients with multiple rib fractures based on use of ON-Q catheter for continuous intercostal nerve blockade
Analgesic requirements (oral morphine equivalents) ON-Q catheter (CATH) No ON-Q catheter (STD) P value All patients CATH (n=48) STD (n=96) Total for hospitalization 2741±1960 3429±4251 0.19 Prior to ON-Q placement 1265±1284 – After ON-Q placement 1477±1247 – Six or more rib fractures CATH (n=39) STD (n=44) Total for hospitalization 2641±1990 4900±5443 0.01 Bilateral rib fractures CATH (n=15) STD (n=46) Total for hospitalization 3292±2317 4660±5259 0.17 Three or more flail segments CATH (n=15) STD (n=16) Total for hospitalization 3569±2671 5678±5834 0.21 Results shown as mean±SD unless otherwise noted.
Estimates from independent t-test.
CATH, patients with multiple rib fractures managed with continuous intercostal nerve blockade; STD, patients with multiple rib fractures managed without continuous intercostal nerve blockade.
- Table 7
OR and associated 95% CI for the association of use of continuous intercostal blockade and outcomes
OR P value 95% CI Unplanned intubation 1.08 0.93 0.18 to 6.49 Failed extubation 0.65 0.51 0.18 to 2.34 Pneumonia 0.15 0.02 0.03 to 0.76 Require tracheostomy 0.23 0.03 0.06 to 0.83 Hospital mortality 0.10 0.04 0.01 to 0.91 Rib fracture complication* 0.26 0.006 0.10 to 0.67 Multivariate logistic regression adjusted for number of rib fractures and number of flail segments.
*Either unplanned intubation, failed extubation, pneumonia, tracheostomy requirement, or hospital mortality.
