Kinesiotaping, single-shot chest wall regional anaesthesia, and Incentive Spirometry for Rib Fracture Management in the Emergency Department: A Systematic Review and Meta-Analysis
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Background
Pain management post-rib fractures is often difficult. High pain levels can lead to altered respiratory mechanics and delayed complications such as poor mobility. Whilst as-needed Opioids are the mainstay of treatment, the potential negative side effects have led to research into alternatives such as kinesiotaping, single-shot chest wall regional anaesthesia, and incentive spirometry.
Methods
A systematic review was undertaken using Medline (Ovid), Emcare, CINAHL, and the Cochrane Library. Article review and selection were undertaken by two independent reviewers using Covidence. Quality was assessed through the Mixed Methods Appraisal Tool (MMAT). Where appropriate, meta-analysis was undertaken using R studio with a REML random effects model. Forest plots were completed, and Higgins’ I 2 and Chi 2 were calculated.
Results
Kinesiotaping demonstrates a reduced pain score than medication alone (SMD: -1.87, 95% CI [-2.65, -1.08]), as did single-shot chest wall regional anaesthesia (SMD: -0.79 [-1.15, -0.01]). The regional anaesthesia group had lower opioid consumption (SMD -0.84 [-2.18, 0.50]) and reduced length of hospital stay (SMD: -0.18 [-0.39, 0.03]) but no change in the risk of complications (RR: 0.92 [0.36, 2.36]). The incentive spirometry group had an increased risk of complications (RR: 3.35 [0.68, 16.44]); however, the causative effect could not be inferred due to significant confounding variables.
Conclusions
Low-to-moderate certainty evidence suggests that kinesiotaping and single-shot chest wall regional anaesthesia may reduce pain in adult emergency department patients with rib fractures. However, evidence is insufficient to show a clear benefit for opioid reduction, length of stay, or complications. The current evidence does not support routine use of incentive spirometry in this setting, but the evidence is severely confounded by baseline injury severity in the current published studies.
Key Messages
What is already known on this subject
Rib fractures are a common presentation to the Emergency Department and are associated with significant pain and respiratory complications.
Opioids are the mainstay of treatment but carry significant side effects, driving the need for multi-modal, opioid-sparing analgesia strategies.
Research Question
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Are kinesiotaping, incentive spirometry and single-shot chest wall regional anaesthesia effective adjuncts to standard analgesia in adult emergency department patients presenting with rib fractures following blunt chest wall trauma?
What this study adds
Kinesiotaping and regional single-shot chest wall regional anaesthesia including serratus anterior plane block and erector spinae plane block, may reduce pain compared to medication alone.
single-shot chest wall regional anaesthesia is associated with reduced total opioid consumption and reduced length of hospital stay in this population.
Current evidence for incentive spirometry is confounded by baseline injury severity, so routine use in the emergency department cannot be supported on the basis of high-quality evidence.
