Operative Treatment of Flail Chest Injuries Does Not Reduce Pain or In-Hospital Opioid Requirements

作者：Niloofar Dehghan, Jessica A. McGraw-Heinrich, Christine E. Schemitsch, Aaron Nauth, Jennifer Hidy, Milena Vicente, Emil H. Schemitsch, Richard Jenkinson, Hans J. Kreder, Michael D. McKee, the Canadian Orthopaedic Trauma Society, the Unstable Chest Wall RCT Study Investigators · 发表于：Journal of Bone and Joint Surgery · 年份：2025 · DOI：10.2106/jbjs.24.01099 · 被引用次数：1 · 研究领域：Trauma Management and Diagnosis、Pneumothorax, Barotrauma, Emphysema、Traumatic Ocular and Foreign Body Injuries

BACKGROUND: A previous randomized controlled trial (RCT) evaluating operative versus nonoperative treatment of acute flail chest injuries revealed more ventilator-free days in operatively treated patients who had been ventilated at the time of randomization. It has been suggested that surgery for these injuries may also improve a patient's pain and function. Our goal was to perform a secondary analysis of the previous RCT to evaluate pain and postinjury opioid requirements in patients with operatively and nonoperatively treated unstable chest wall injuries. METHODS: We analyzed data from a previous multicenter RCT that had been conducted from 2011 to 2019. Patients who had sustained acute, unstable chest wall injuries were randomized to operative or nonoperative treatment. In-hospital pain medication logs were evaluated, and daily morphine milligram equivalents (MMEs) were calculated. The patients' symptoms were also assessed, including generalized pain, chest wall pain, chest wall tightness, and shortness of breath. Additionally, patients completed the 36-Item Short Form Health Survey (SF-36), and they were followed for 1 year postinjury. RESULTS: In the original trial, 207 patients were analyzed: 99 patients received nonoperative treatment, and 108 received operative treatment. There were no significant differences in pain medication usage between the 2 groups at any of the examined time points (p = 0.477). There were no significant differences in generalized pain, chest wa...