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Rib Fracture Epidural Analgesia — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaRib Fracture Epidural AnalgesiaFRCA Final

A 45-year-old man sustains multiple rib fractures (ribs 4-10 right side) with a flail segment after a fall from height. He is in the emergency department with paradoxical chest wall movement, SpO2 91%, and pain score 10/10. Regarding analgesia, which technique provides the best pain relief for multiple rib fractures?

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Correct answer: D — Thoracic epidural analgesia

Thoracic epidural analgesia provides the best evidence-based pain relief for multiple rib fractures. It allows deep breathing, effective coughing, and chest physiotherapy – all of which reduce pulmonary complications (pneumonia, atelectasis, respiratory failure). The NICE NG39 and BTS guidelines recommend early regional analgesia for rib fractures. If epidural is contraindicated (anticoagulation, coagulopathy, patient refusal), alternatives include: paravertebral block/catheter, serratus anterior plane block, or erector spinae plane block. Oral/IV analgesics alone are inadequate for severe rib fracture pain.

Reference: NICE – 2023 – NG39 Major trauma; BTS – 2023 – Blunt chest trauma guidelines