Erector spinae and serratus anterior blocks for the management of rib fractures: A retrospective exploratory matched study

Riley, Brooke; Malla, Utsav; Snels, Nicholas; Mitchell, Andrew R.J.; Abi-Fares, C.; Basson, Willem; Anstey, Chris; White, Leigh

doi:10.1016/j.ajem.2020.01.007

Cited by 21 publications

(26 citation statements)

References 6 publications

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“…Alternative LRA modalities that act more peripherally offer unique advantages over thoracic epidural catheters and are increasingly studied in the rib fracture population. 25,26 As intraoperative LRA modalities, both IC and LB share an additional advantage of placement under direct visualization by surgeons. Before this trial, our preferred LRA modality for patients admitted with rib fractures, regardless of surgical candidacy, was IC.…”

Section: Discussionmentioning

confidence: 99%

A randomized clinical trial of single dose liposomal bupivacaine versus indwelling analgesic catheter in patients undergoing surgical stabilization of rib fractures

Leasia¹,

Ciarallo²,

Prins³

et al. 2021

J Trauma Acute Care Surg

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Locoregional analgesia (LRA) remains underused in patients with chest wall injuries. Surgical stabilization of rib fractures (SSRF) offers an opportunity to deliver surgeon-directed LRA under direct visualization at the site of surgical intervention. We hypothesized that a single-dose liposomal bupivacaine (LB) intercostal nerve block provides comparable analgesia to an indwelling, peripheral nerve plane analgesic catheter with continuous bupivacaine infusion (IC), each placed during SSRF. METHODS:Noninferiority, single-center, randomized clinical trial (2017-2020) was performed. Patients were randomized to receive either IC or LB during SSRF. The IC was tunneled into the surgical field (subscapular space), and LB involved thoracoscopic intercostal blocks of ribs 3 to 8. The primary outcome was the Sequential Clinical Assessment of Respiratory Function score, measured daily for 5 days postoperatively. Secondary outcomes included daily narcotic equivalents and failure of primary LRA, defined as requiring a second LRA modality. RESULTS:Thirty-four patients were enrolled: 16 IC and 18 LB. Age, Injury Severity Score, RibScore, Blunt Pulmonary Contusion Score, and use of nonnarcotic analgesics was similar between groups. Duration of IC was 4.5 days. There were three failures in the IC group versus one in the LB group (p = 0.23). There was no significant difference in Sequential Clinical Assessment of Respiratory Function score between the IC and LB groups. On postoperative days 2 to 4, narcotic requirements were less than half in the LB, as compared with the IC group; however, this difference was not statistically significant. Average wholesale price was US $605 for IC and US $434 for LB. CONCLUSION:In this noninferiority trial, LB provided at least comparable and potentially superior LRA as compared with IC among patients undergoing SSRF.

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Section: Discussionmentioning

confidence: 99%

A randomized clinical trial of single dose liposomal bupivacaine versus indwelling analgesic catheter in patients undergoing surgical stabilization of rib fractures

Leasia¹,

Ciarallo²,

Prins³

et al. 2021

J Trauma Acute Care Surg

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“…There is no evidence to support the use of ESP or SAP catheters over TE or PVB, but these superficial blocks have less contraindications and potential adverse effects 5,6,11 . The decision to place one block over the other was based on fracture location and clinician preference.…”

Section: Discussionmentioning

confidence: 99%

“…The present case series received institutional approval (HREC:LNR/2018/QPCH/45155) and informed consent was waived by the institutional review board. Ten consecutive patients 65 years and over with eight or more rib fractures were identified from a larger study 5,6 . No patients meeting these criteria were excluded from this series.…”

Section: Case Seriesmentioning

confidence: 99%

“…4 Recently, several novel chest wall blocks such as the erector spinae plane (ESP) and serratus anterior plane (SAP) blocks have gained favour. 5,6 However, these have been suggested to be inferior to the more traditional TE and PVB. 7 To date, the limitations of these newer blocks, such as the number of fractures that can be managed by a single ESP or SAP, have not been explored.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, several novel chest wall blocks such as the erector spinae plane (ESP) and serratus anterior plane (SAP) blocks have gained favour 5,6 . However, these have been suggested to be inferior to the more traditional TE and PVB 7 .…”

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confidence: 99%

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Novel chest wall blocks for severe chest wall injuries in older persons: A case series

Riley

Malla

Snels

et al. 2021

Trauma

Self Cite

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Patients over the age of 65 years admitted to hospital with more than six rib fractures have a mortality rate as high as 38%. Of the survivors, 34% are likely to be admitted to an aged care facility. High-quality analgesia is paramount to the mitigation of rib fracture–associated morbidity and mortality. We report a series of ten consecutive patients over the age of 65 years with more than eight fractured ribs. All patients were managed with a novel chest wall block. There were no deaths, and only one patient was discharged into an aged care facility.

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Polytraumatized Patients: Blunt Chest Trauma

Nair,

Esquinas

2023

Noninvasive Ventilation. The Essentials

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Erector spinae and serratus anterior blocks for the management of rib fractures: A retrospective exploratory matched study

Cited by 21 publications

References 6 publications

A randomized clinical trial of single dose liposomal bupivacaine versus indwelling analgesic catheter in patients undergoing surgical stabilization of rib fractures

A randomized clinical trial of single dose liposomal bupivacaine versus indwelling analgesic catheter in patients undergoing surgical stabilization of rib fractures

Novel chest wall blocks for severe chest wall injuries in older persons: A case series

Polytraumatized Patients: Blunt Chest Trauma

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