Single-shot regional anesthesia likely reduces early pain and opioid use in rib fracture patients

STUDY OBJECTIVE: Regional anesthesia techniques for traumatic rib fractures are rapidly being adopted by clinicians in emergency medicine to augment early pain management; however, the impact of "single-shot" techniques remains unclear. This systematic review and network meta-analysis was designed to identify the most effective single-shot regional anesthesia (SSRA) techniques on early pain reduction and other outcomes in adult patients with rib fractures. METHODS: We searched PubMed, MEDLINE, EMBASE, CINAHL, and CENTRAL for randomized clinical trials that compared SSRA techniques for the purpose of rib fracture management. The primary outcome was pain score reported at 4-8 h. Secondary outcomes included pain scores to 24 h, respiratory function, opioid requirements, respiratory and procedural complications, hospital length of stay, and mortality. A random-effects meta-analysis was performed on pooled data for each pairwise comparison with effect sizes expressed as weighted mean differences (MD). Network meta-analysis was conducted using a Bayesian framework to simultaneously compare multiple treatments via a common comparator (standard care). RESULTS: We included nine randomized clinical trials with 738 patients. The pooled estimated MD in pain scores at 4-8 h for SSRA techniques compared to standard care -1.81 (95% credible interval [CrI], -2.11 to -1.51; moderate certainty). SSRA was also associated with a significant reduction in opioid requirements at 24 h (MD, -9.35 [95% CrI -11.1 to -7.59]; moderate certainty). NMA failed to demonstrate that any one SSRA technique was more conclusively beneficial than another. Confidence in these results was moderate to low, due to inconsistency in the control arms, imprecision of results, and substantial heterogeneity. CONCLUSION: The use of SSRA techniques compared to standard care or placebo likely reduces pain scores in the early phase of management of patients with rib fractures. Further studies using standardized controls are required to delineate superiority between different SSRA techniques. TRIAL REGISTRATION: PROSPERO Registration: CRD420251003934.