LAUSR

Trauma is the third most common cause of death in adults in the United States, accounting for ~170,000 deaths, or 7.6% and 4.4% of all US deaths in males and females, respectively. Thoracic injuries account for up to a quarter of these deaths and are also a major source of mortality and morbidity among combat casualties (4.9% to 9.9% of all casualties). Trauma can be penetrating or blunt and can affect any component of the chest wall or thorax. Penetrating trauma frequently requires immediate surgical intervention in survivors, whereas blunt chest trauma is often initially managed conservatively by support of injured organ systems. Rib fractures represent a large proportion of chest trauma and are clinically significant due to decreased oxygenation from pulmonary contusions, decreased respiratory function from mechanical disruption and pain-related chest wall splinting, and from associated extrathoracic injuries. Mortality and morbidity among patients with rib fractures have been shown to be directly correlated with the number of fractured ribs, age of the patient, and injury severity score (ISS). In this article, we discuss the importance of good pain control in the management of thoracic trauma and the available evidence supporting the available modalities including nonpharmacological, pharmacological, regional analgesia, and surgical fixation.