What is the treatment for fractured ribs in an elderly female?

From the Guidelines

The treatment for fractured ribs in an elderly female should prioritize a multimodal analgesic approach, including the association of systemic analgesic treatment with thoracic epidural and paravertebral blocks, to offer adequate pain control with limited contraindications and improvement in respiratory function, reducing opioid consumption, infections, and delirium, if skills are available 1.

Key Considerations

• Pain management is crucial to prevent complications such as pneumonia and respiratory failure.
• A multimodal analgesic approach, including acetaminophen, gabapentinoids, NSAIDs, lidocaine patches, and opioids only for breakthrough pain, is recommended 1.
• Thoracic epidural and paravertebral blocks can be considered for elderly patients with rib fractures to reduce opioid consumption and improve respiratory function 1.
• Gentle mobilization should begin as soon as pain allows, typically within 1-2 days, to prevent prolonged bed rest and its associated complications.
• Deep breathing exercises and the use of an incentive spirometer can help prevent pneumonia and promote healing.

Treatment Approach

• Acetaminophen (500-1000mg every 6 hours, not exceeding 3000mg daily for elderly patients) can be used as a first-line treatment for pain management.
• NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) can be considered if not contraindicated by kidney issues or bleeding risk.
• Short-term opioids such as hydrocodone/acetaminophen 5/325mg every 6 hours for 3-5 days may be necessary for moderate to severe pain.
• Applying ice packs for 20 minutes every 2-3 hours can reduce pain and swelling.

Monitoring and Follow-up

• The patient should be monitored for complications such as pneumonia, respiratory failure, and delayed healing.
• Immediate medical attention should be sought if the patient experiences increased shortness of breath, fever, or worsening pain.
• Regular follow-up appointments should be scheduled to assess the patient's progress and adjust the treatment plan as needed.

From the Research

Treatment for Fractured Ribs in Elderly Females

The treatment for fractured ribs in elderly females typically involves a multimodal approach to manage pain and prevent complications.

• The primary goal of care is to provide sufficient analgesia to allow respiratory rehabilitation and prevent pulmonary complications 2.
• A study found that oral acetaminophen is equivalent to intravenous acetaminophen for pain control in elderly trauma patients with rib fractures, with no difference in morbidity or mortality 3.
• Regional anesthesia techniques, such as thoracic epidural analgesia, paravertebral block, serratus anterior plane block, and erector spinae block, have been shown to be effective in alleviating pain related to rib fractures 4, 5.
• A comprehensive review of current pain management in rib fractures provides practical guidelines for clinicians, including a brief review of the anatomy of the thorax, the latest trends in pharmacologic and noninvasive means of managing rib pain, and a review of the recent literature on rib plating 6.
• The use of analgesia algorithms may aid early aggressive management and escalation of pain control 2.
• The current role for surgical fixation of rib fractures remains unclear for older adults, who have been underrepresented in the research literature 2.

Analgesic Options

• Acetaminophen is a commonly used analgesic for managing pain associated with rib fractures 3, 4.
• Nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, lidocaine, and dexmedetomidine are also used as part of a multimodal analgesic approach 4.
• Opioid analgesics are often used, but their use is limited due to adverse effects 5.

Regional Anesthesia Techniques

• Thoracic epidural analgesia has positive analgesic effects, but is contraindicated for many patients 5.
• Paravertebral block is a viable alternative to thoracic epidural analgesia, but has a failure rate of up to 10% and adverse complications 5.
• Serratus anterior plane block and erector spinae block are practical alternatives to thoracic epidural analgesia or paravertebral block, with lower incidences of adverse effects and similar levels of analgesia 5.