Application of multi-mode combined analgesia in the early stage of non-operative treatment of traumatic rib fractures in adults

Objective To evaluate the analgesic effect of a new combined analgesic mode in the early stage of non-operative treatment of adult traumatic rib fractures. Methods A total of 93 patients with rib fractures who did not receive surgical treatment from January 2014 to January 2018 were prospectively included, and randomly divided into the traditional analgesia group, subcutaneous analgesia group and combined analgesia group(31 cases each). There were 56 males and 37 females totally with a median age of(47.3±13.2)years. All patients have moderate to severe pain with VAS scores greater than 5. Traditional analgesia group: lornoxicam 8 mg intravenous injection twice daily. Subcutaneous analgesia group: only subcutaneous self-controlled analgesia pump was used for treatment. Combined analgesia group: on the basis of the traditional analgesia group, subcutaneous self-controlled analgesia pump was added for treatment, and the dosage of the pump drug was the same as that of subcutaneous analgesia group. The VAS scores at tranquillization and cough were compared before analgesia treatment(T1), 24 h(T2), 48 h(T3) and 72 h(T4) after analgesic treatment in each group during bed brake within 3 days after injury. The VAS scores after 78 hours of analgesic treatment during ambulation were compared. When sudden pain with VAS score greater than 7 occurred within 72 hours of bed staying treatment in each group, the average daily use times of bucinnazine hydrochloride 100mg remedial analgesia were compared. The number of adverse reactions such as nausea and pneumonia in each group was compared. Results The VAS scores of resting pain and cough pain at the observation time point(T2-T4) in the combined analgesia group were better than those in the subcutaneous analgesia group and the traditional analgesia group, showing a significant difference(P<0.05). When getting out of bed, there were significant differences in pain scores among the three groups, and the pain score of the combined analgesia group was the lowest. There was a significant difference among the three groups in the number of daily additions of bucinnazine hydrochloride during remedial analgesia(P<0.05), the combined analgesia group was the least. Between the two groups of patients using analgesic pump, the number of self-compressions in the combined analgesia group was lower than that in the subcutaneous analgesia group(P<0.05). The incidence of pneumonia in the combined analgesia group was lower than that in the other two groups and the incidence of other adverse reactions such as nausea was lower than that in the simple analgesia group. Conclusion In the early stage of non-operative treatment of traumatic rib fractures in adults, the multi-mode analgesic effect of traditional intravenous intermittent administration combined with subcutaneous continuous administration is superior to the single analgesic mode of traditional intravenous or subcutaneous administration with no obvious adverse reactions. Key words: Multi-mode combined analgesia; Rib fractures; Non-operative treatment; Patient-controlled subcutaneous analgesia