title: Pain as an indication for rib fixation: a bi-institutional pilot study.
abstract: BACKGROUND
  In trauma patients, open reduction and internal fixation of rib fractures remain controversial. We hypothesized that patients who have open reduction and internal fixation of rib fractures would experience less pain compared with controls and thus require fewer opiates. Further, we hypothesized that improved pain control would result in fewer pulmonary complications and decreased length of stay.
  
  
  METHODS
  This is a retrospective bi-institutional matched case-control study. Cases were matched 1:2 by age, injury severity Score, chest abbreviated injury severity score, head abbreviated injury severity score, pulmonary contusion score, and number of fractured ribs. The daily total doses of analgesic drugs were converted to equianalgesic intravenous morphine doses, and the primary outcome was inpatient narcotic administration.
  
  
  RESULTS
  Sixteen patients between July 2005 and June 2009 underwent rib fixation in 5 ± 3 days after injury using an average of 3 (1-5) metallic plates. Morphine requirements decreased from 110 mg ± 98 mg preoperatively to 63 ± 57 mg postoperatively (p = 0.01). There were no significant differences between cases and controls in the mean morphine dose (79 ± 63 vs. 76 ± 55 mg, p = 0.65), hospital stay (18 ± 12 vs. 16 ± 11 days, p = 0.67), intensive care unit stay (9 ± 8 vs. 7 ± 10 days, p = 0.75), ventilation days (7 ± 8 vs. 6 ± 10, p = 0.44), and pneumonia rates (31% vs. 38%, p = 0.76).
  
  
  CONCLUSIONS
  The need for analgesia was significantly reduced after rib fixation in patients with multiple rib fractures. However, no difference in outcomes was observed when these patients were compared with matched controls in this pilot study. Further study is required to investigate these preliminary findings.
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. mdemoya@partners.org
authors.forename: Marc
authors.initials: M
authors.lastname: de Moya
authors.forename: Thanos
authors.initials: T
authors.lastname: Bramos
authors.forename: Suresh
authors.initials: S
authors.lastname: Agarwal
authors.forename: Karim
authors.initials: K
authors.lastname: Fikry
authors.forename: Sumbal
authors.initials: S
authors.lastname: Janjua
authors.forename: David R
authors.initials: DR
authors.lastname: King
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: Peter
authors.initials: P
authors.lastname: Burke
authors.forename: William
authors.initials: W
authors.lastname: Tobler
mesh_terms: D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D005409:Flail Chest / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D010865:Pilot Projects; D011859:Radiography; D012189:Retrospective Studies; D012253:Rib Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid