Regional Analgesic and Opioid Usage in Patients Hospitalised with Rib Fractures in a Regional Hospital in New Zealand
Presenter: Dr Kasia Hunt, Emergency Medicine Specialist, Te Whatu Ora MidCentral
Authors List
McCormack, N. Palmerston North Hospital, Palmerston North, New Zealand
Bignell, H. Palmerston North Hospital, Palmerston North, New Zealand
Rider, S. Palmerston North Hospital, Palmerston North, New Zealand
Hunt, K. M. Palmerston North Hospital, Palmerston North, New Zealand
Introduction
Interest in the use of erector spinae block (ESB) as an opioid-sparing analgesic in chest trauma has increased internationally. In July 2025, the New Zealand (NZ) National Chest Trauma pathway was published, recommending ESB use in specific populations.
Aims
To compare ESB usage and opioid requirements in patients hospitalised with rib fractures at Palmerston North Hospital (PNH).
Methods
A retrospective analysis of PNH trauma admission data between 1 January and 31 December 2025 was performed. Inclusion criteria were isolated rib fractures and any associated lung injury, with a complete dataset and admission solely within PNH. Oral morphine equivalent was calculated using The Australian and New Zealand College of Anaesthetists Faculty of Pain Medicine calculator. Rib fracture severity was assessed using the STUMBL score.
Results
Sixty-eight patients were enrolled. Median age was 75 (range 27-94) and 26 (38.2%) were women. 81% were NZ or Other European, 12% were NZ Māori and 7% were Asian. Thirty patients (44%) received an ESB. The ESB subgroup had significantly higher STUMBL scores than the non-ESB subgroup (mean 22.2 vs. 16.1, p < 0.001). The ESB subgroup also had higher inpatient opioid consumption (median 137.25 vs. 60 mg, p = 0.011). However, discharge opioid use did not differ significantly between the ESB and non-ESB subgroups (p = 0.18). In addition, 83% of patients in the ESB subgroup received Patient Controlled Analgesia (PCA), compared to 39% in the non-ESB subgroup (p < 0.001)
Conclusions
Higher opioid use in patients who received ESB is multifactorial and could represent more severe injury, increased frailty, greater access to opioids via PCA, or higher analgesic requirements prior to ESB placement.
References: Health New Zealand National Chest Trauma Pathway. https://static.info.content.health.nz/docs/Chest%20Injury%20Guideline.pdf. Accessed July 2026.
McCormack, N. Palmerston North Hospital, Palmerston North, New Zealand
Bignell, H. Palmerston North Hospital, Palmerston North, New Zealand
Rider, S. Palmerston North Hospital, Palmerston North, New Zealand
Hunt, K. M. Palmerston North Hospital, Palmerston North, New Zealand
Introduction
Interest in the use of erector spinae block (ESB) as an opioid-sparing analgesic in chest trauma has increased internationally. In July 2025, the New Zealand (NZ) National Chest Trauma pathway was published, recommending ESB use in specific populations.
Aims
To compare ESB usage and opioid requirements in patients hospitalised with rib fractures at Palmerston North Hospital (PNH).
Methods
A retrospective analysis of PNH trauma admission data between 1 January and 31 December 2025 was performed. Inclusion criteria were isolated rib fractures and any associated lung injury, with a complete dataset and admission solely within PNH. Oral morphine equivalent was calculated using The Australian and New Zealand College of Anaesthetists Faculty of Pain Medicine calculator. Rib fracture severity was assessed using the STUMBL score.
Results
Sixty-eight patients were enrolled. Median age was 75 (range 27-94) and 26 (38.2%) were women. 81% were NZ or Other European, 12% were NZ Māori and 7% were Asian. Thirty patients (44%) received an ESB. The ESB subgroup had significantly higher STUMBL scores than the non-ESB subgroup (mean 22.2 vs. 16.1, p < 0.001). The ESB subgroup also had higher inpatient opioid consumption (median 137.25 vs. 60 mg, p = 0.011). However, discharge opioid use did not differ significantly between the ESB and non-ESB subgroups (p = 0.18). In addition, 83% of patients in the ESB subgroup received Patient Controlled Analgesia (PCA), compared to 39% in the non-ESB subgroup (p < 0.001)
Conclusions
Higher opioid use in patients who received ESB is multifactorial and could represent more severe injury, increased frailty, greater access to opioids via PCA, or higher analgesic requirements prior to ESB placement.
References: Health New Zealand National Chest Trauma Pathway. https://static.info.content.health.nz/docs/Chest%20Injury%20Guideline.pdf. Accessed July 2026.
