Regional analgesia for chest wall injuries related to cardiopulmonary resuscitation: retrospective service evaluation and injury pattern mapping.

Cardiopulmonary resuscitation frequently results in rib and sternal fractures. Regional analgesia is recommended in blunt chest trauma, but its role in injuries related to cardiopulmonary resuscitation is not well defined. This study aimed to characterise injury patterns and evaluate regional analgesia use in patients recovering from cardiac arrest. A retrospective service evaluation was undertaken at a tertiary centre over 2 years. Adults referred to the Acute Pain Service following return of spontaneous circulation were included. Data collected included patient characteristics, imaging, fracture distribution, STUdy of the Management of BLunt chest wall trauma (STUMBL) score, regional analgesia use and ventilatory requirements. Eighty-one patients with chest wall injuries related to cardiopulmonary resuscitation (24% of all cardiac arrests) were referred. Rib fractures were identified in 84% and sternal fractures in 34% of patients; median STUMBL score was 38. Anterolateral fractures and anterior fractures were the most common. Referrals occurred a median of 2 days after the cardiac arrest. Regional analgesia was delivered to 40% of patients by the third day after the cardiac arrest. Fascial plane blocks predominated (92%), with technique selection influenced by operator expertise, fracture distribution and ease of insertion in the supine position. Analgesic effect was recorded as marked or moderate in 90%. Forty-three per cent of the referrals were for patients who were mechanically ventilated, and 54% of them received regional analgesia. Chest wall injuries associated with cardiopulmonary resuscitation at our institution were common and frequently received regional analgesia. Injury patterns favoured anterior techniques, although prospective evaluation of effectiveness is required.