Internal Reference Number: FOI_9470
Date Request Received: 19/06/2026 00:00:00
Date Request Replied To: 23/07/2026 00:00:00
This response was sent via: By Email
Request Summary: Regional anaesthesia for rib fractures
Request Category: Health
| Question Number 1: I am writing to you under the Freedom of Information Act 2000 to request the information found below regarding the management of acute traumatic rib fractures. Single-shot chest wall blocks in the Emergency Department a. Does your Trust provide single-shot ultrasound-guided chest wall blocks (e.g. serratus anterior plane block [SAPB] or erector spinae plane block [ESPB]) for adults with traumatic rib fractures in the Emergency Department prior to hospital admission? If yes: b. Which specialty or specialties perform these blocks (e.g. Emergency Medicine, Anaesthetics, Critical Care)? c. Are these blocks delivered as part of a formal pathway or standard clinical practice? d. Following a single-shot block, is it standard practice for patients to be considered for escalation to a continuous chest wall catheter (e.g. SAPB or ESPB catheter) and/or epidural analgesia? If not: e. If single-shot chest wall blocks are not routinely performed in the Emergency Department, are they routinely performed later during the patient's admission for traumatic rib fractures? f. Which specialty or specialties perform these blocks ? | |
| Answer To Question 1: 1a. No. Currently reviewing this process and will need to upskill staff in ED. | |
| Question Number 2: Continuous chest wall catheter techniques a. Does your Trust provide continuous chest wall catheter techniques (e.g. SAPB or ESPB catheters) for adults admitted with traumatic rib fractures? If yes: b. Which specialty or specialties perform these procedures? c. In which clinical areas are these procedures typically performed (e.g. Emergency Department, Anaesthetic Room, Operating Theatre, Critical Care Unit, Ward)? d. Are patient selection criteria used (e.g. STUMBL Score, Battle Score, RibScore, or other risk stratification tools)? If so, please specify. | |
| Answer To Question 2: 2a. Yes 2b. Provided currently mainly by anaesthetics whilst ED clinicians with interest and USS skills are upskilling. 2c. ED, ward, anaesthetic room 2d. Battle score. | |
| Question Number 3: Policy and guidance a. Please attach a copy of all the specific guidelines and/or protocol and/or standard operational procedure for the chest wall blocks (including any competence/training/education if one is in place) If no specific local guideline or SOP exists for this, please explicitly state 'No local guideline held' | |
| Answer To Question 3: 3. Rib fracture pathway To accompany this answer to question 3 please also see the documents listed below:  Rib Fracture pathway UTD 2024.pdf | |
| Question Number 4: Physiotherapy management of rib fractures a. Does your Trust provide specific physiotherapy interventions for adults with traumatic rib fractures, including patients discharged directly from the Emergency Department? Examples may include incentive spirometry, breathing exercises, respiratory physiotherapy, kinesiology taping (K-tape), or other structured interventions. If yes: b. Please describe the interventions provided. c. Please provide copies of any associated guidelines, pathways, SOPs, patient information leaflets, or physiotherapy protocols. If no such documents are held, please state: "No local guideline held." | |
| Answer To Question 4: 4a. Yes 4b. Breathing exercise 4c. No local clinical guidelines held | |
| Question Number 5: Other rib fracture management pathways a. Please provide copies of any additional local guidelines, pathways, SOPs, protocols, or care bundles relating to the management of adults with traumatic rib fractures that have not already been provided in response to Questions 3 and 4. This includes the Emergency Department, inpatient, surgical, medical, trauma, critical care, and physiotherapy pathways. If no additional documents are held, please state: "No other local guideline held." | |
| Answer To Question 5: 5. No other local clinical guideline held. | |
| Question Number 6: Patient disposition a. For adults with multiple traumatic rib fractures who do not require Level 2 or Level 3 care, to which ward or specialty area are they most commonly admitted? | |
| Answer To Question 6: 6. Below 75 years of age under General Surgery (but with frailty input if high CFS). 75 or older admitted under medics. | |
| Question Number 7: Specialty a. 鈥� In your Trust, which parent speciality or specialities (e.g. Emergency Medicine, Frailty, Respiratory, Trauma & Orthopaedics, Cardiothoracic, or General Surgery) mainly look after adults with multiple rib fractures from blunt chest wall trauma as an inpatient for the first 5-7 days? | |
| Answer To Question 7: 7. As per answer 6. | |
| Please see Attachments: | |
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