Chest Wall Injury (Rib Fractures)


This page contains the criteria for urgent referral of patients with chest wall injury (esp. elderly patients with rib fractures) to the SCGH Acute Pain Service, for consideration of thoracic paravertebral block / PCA, aswell as some additional resources to assist in the analgesic management of this patient group


With regard to patients with chest injury, the earlier pain is controlled, the less likely patients will suffer complications from inadequate pain control, splinting OR excessive narcotisation. This is especially the important in elderly patients and patients with significant comorbidities. There is an agreement at SCGH between Pain Service, Trauma Service and the ED, that any patient with the following criteria should be referred to the Acute Pain Service (which is available for referral 24/7).

Criteria for urgent referral to acute pain team:

  •  > 65 years old


  • significant comorbidities


  • no enteral route available


  • > 2 rib fractures.


The Acute pain team page 4120 during normal working hours (CNS) and page 4823 (anaes reg) after hours/ weekends.


For additional information:

intercostal nerve pic
Paravertebral Block
Intercostal Block

Date implemented – 11/2014
Review date – 11/2017
Author – APS, Trauma, ED


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