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Ribs are frequently affected after a blunt or penetrating thoracic trauma. Acute key complications associated with rib fractures include pain, hemo-pneumothorax, extrapleural hematoma, pulmonary contusion and laceration, and vascular injury. In high energy traumas, injuries to abdominal solid organs may also coexist. A later complication that can limit the weaning of patients from sedation and ventilation is neuropathic pain, which is frequently associated with rib fractures and that is often poorly responsive to oral and topical medications. The benefit of interventional nerve block procedures is still controversial. Ultrasound-guided erector spinae plane (ESP) block is a relatively new technique for thoracic analgesia that can be both a simpler and safer alternative to more complex and invasive neural blocking techniques, especially in intensive care unit patients whereas major contraindications (i.e. coagulation alteration, infection etc.) might limit the feasibility of more invasive methods, such as central blocks.

Dear Editor, The problem of analgosedation in Intensive Care Units is as old as the Intensive Care Unit itself, but it is only in recent years that the importance of the "fifth vital parameter" in terms of association has been recognized not only as immediate complications such as agitation and delirium but also in the long term with post-traumatic stress disorder, chronic pain, and reduced quality of life after discharge, so much so as to recognize the need to adopt pain and agitation control scales even in non-communicating patients or patients with altered mental status.1[...]

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