Local Infiltration of Liposomal Bupivacaine in Isolated Traumatic Rib Fractures

Abstract

Introduction: Adequate pain control is essential in the management of traumatic rib fractures. Local infiltration of liposomal bupivacaine (LB) to provide intercostal nerve block has been added to the multimodal pain control regimens. We explored the effectiveness of LB infiltration around the site of rib fracture on pain score and total opioid use.

Methods: Patients with isolated rib fractures receiving additional infiltration of LB at the fracture site were compared to patients receiving only conservative treatment. A linear mixed model was performed to evaluate the impact of LB on pain score and total opioid use [morphine milligram equivalent per day (MME)].

Results:  Patients in the LB group experienced slightly, but insignificantly, greater pain scores. The adjusted mean MME was significantly higher compared to control (44.6 vs 24.4, p= 0.01), and increased over time (∆=5.7 and 6.6, p= 0.03 respectively at ~48h and ~96h, respectively).

Conclusion: No significant reductions in pain score and opioid requirement were achieved by additional local infiltration of LB in patients with isolated traumatic rib fractures.