Comparison of efficacy of Tapentadol nasal spray vs multimodal systemic analgesia for pain control in patient with multiple rib fracture

Patients with chest trauma admitted through the emergency department will be managed as per ATLS guidelines, including resuscitation, stabilization, IV analgesics, intercostal nerve block, antibiotics, oxygen support and, if indicated intercostal chest drainage . After stabilization of patient and taking informed consent, they will be randomized by computer-generated numbers into two groups. Group A will receive Tapentadol nasal spray (22.5 mg per nostril, four times daily) along with intercostal nerve block . Group B will receive multimodal systemic analgesia (Tramadol, Paracetamol, Diclofenac in rotation) along with intercostal nerve block  as required. For initial 48 hours, Group A and Group B patients will receive blanket cover of intercostal nerve block (twice a day) and multimodal systemic analgesia /Tapentadol nasal spray. In both the groups, after 48 hours, rescue analgesia with injection diclofenac will be given whenever the pain score is >4. For assessment of pain VAS score is used, a 10-cm line marked on paper, with 0 meaning no pain and 10 denoting maximum pain will be used . Appropriate statistical test of significance will be used to study the differences between both the groups.