Erector Spinae Plane Block as an Analgesic Intervention in Acute Rib Fractures: A Scoping Review

Abstract

Rib fractures are a common sequelae of chest trauma and are associated with significant morbidity. The erector spinae nerve block (ESB) has been proposed as an alternative first-line regional technique for rib fractures due to ease of administration and minimal complication profile. We aimed to investigate the current literature surrounding this topic with a focus on pain and respiratory outcomes. Methods: A comprehensive literature search was performed on the Medline, Embase, Web of Science, Scopus, and Cochrane databases. Keywords of "erector spinae block" and "rib fractures" were used to form the search strategy. Papers published in English investigating ESB as an analgesic intervention for acute rib fracture were included. Exclusion criteria were operative rib fixation, or where the indication for ESB was not rib fracture. Results: There were 37 studies which met the inclusion criteria for this scoping review. Of these, 31 studies reported on pain outcomes and demonstrated a 40% decrease in pain scores post administration within the first 24 hours. Respiratory parameters were reported in 8 studies where an increase in incentive spirometry was demonstrated. Respiratory complication was not consistently reported. ESB was associated with minimal complications; only 5 cases of haematoma and infection were (incidence 0.6%) reported, none of which required further intervention. Discussion: Current literature surrounding ESB in rib fracture management provides a positive qualitative evaluation of efficacy and safety. Improvements in pain and respiratory parameters were almost universal. The notable outcome from this review was the improved safety profile of ESB. The ESB was not associated with complications requiring intervention even in the setting of anticoagulation and coagulopathy. There still remains a paucity of large cohort, prospective data. Moreover, no current studies reflect an improvement in respiratory complication rates compared to current techniques. Taken together, these areas should be the focus of any future research.

Effective Postoperative Pain Management in Thoracic Outlet Syndrome Surgery: The Role of the Erector Spinae Plane Block

“…The needle is directed towards the transverse process at the desired level, which serves as a safe stop, in this case, at the level of T1, and the local anesthetic hydro-dissects the plane beneath the erector spinae muscle. The mechanism of this block is not fully understood, but it is attributed to the possible spread to the paravertebral space and laterally to the intercostal nerves [ 8 ]. The injection into the surgical wound aims to cover the sensory nerves originating from the high cervical roots, likely not encompassed by the ESP block.…”

Менеджмент Болю При Множинних Переломах Ребер: Огляд

“…An MRI study has shown the transforam inal and epidural spread of the local anaesthetic which might be advantageous for the visceral, including pleu ritic pain which often accompanies rib fractures (66). A perineural catheter then can be inserted for prolonged analgesia which is usually required for a patient with rib fractures (67). Erector Spinae Plane block's efficacy for rib fractures has been described in case series (59,(68)(69)(70)(71)(72) as well as in retrospective cohort, prospective and randomised controlled studies (68,(73)(74)(75)(76)(77)(78)(79).…”

Erector spinae plane blocks: A narrative update

“…and forced vital capacity. 15 Children whose chest wall is more compliant are less likely to have rib fractures, but ESPB can be used for multiple fractures.…”

“…Pain related to rib fractures can also be managed using ESPB. Most studies published to date are in adults and show improved pain scores and improved respiratory function using incentive spirometry and forced vital capacity 15 . Children whose chest wall is more compliant are less likely to have rib fractures, but ESPB can be used for multiple fractures.…”