Erector spinae plane block for multiple rib fracture done by an Emergency Physician: A case series

Gaurav, Kumar; Bhoi, Sanjeev; Sinha, Tej Prakash; Paul, Shubhankar

doi:10.1002/ajum.12225

Cited by 16 publications

(8 citation statements)

References 16 publications

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“…In this study, it was observed that there was a statistically significant reduction in the pain scores in the ESPB group up through 120 min. A similar reduction in pain was noted in a case series conducted in an ED 22 . However, they were able to follow the patient only up to 2 h postprocedure following which the patients were either shifted to wards or had to go to a different hospital.…”

Section: Discussionsupporting

confidence: 60%

“…A similar reduction in pain was noted in a case series conducted in an ED. 22 However, they were able to follow the patient only up to 2 h postprocedure following which the patients were either shifted to wards or had to go to a different hospital. Another retrospective study done in a Level I trauma center found that the mean pain scores were reduced from 7.7 to 4.7 in the first 3 h postintervention.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of ultrasound‐guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial

Ramesh,

Ayyan,

Rath

et al. 2023

Academic Emergency Medicine

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ObjectivesThe primary objective was to compare the analgesic efficacy of Ultrasound‐guided Erector Spinae Plane block (ESPB) with a sham procedure in adult patients presenting with rib fractures to the Emergency department (ED).MethodsA randomized controlled trial was conducted at an academic ED over a 17‐month period. Forty‐six adults with confirmed rib fractures and numeric rating score (NRS) greater than 4 were randomized to one of two treatment arms: ultrasound‐guided ESPB group or placebo (sham procedure). Intravenous opioids were prescribed as rescue analgesia when self‐reported pain scores were >/=4. The primary outcome measure, pain intensity reduction, was derived using the 11‐point NRS at six‐time points over 12 hours. Secondary outcome measures included the amount of rescue analgesia, in morphine equivalents, and the occurrence of adverse events. Two‐way repeated measures ANOVA was used to compare the trend in NRS scores across the two arms. The association between the complications and intervention was explored using the Fisher's Exact test.ResultsForty‐six patients (23 in each arm) completed the study. There was no difference between treatment groups with respect to age, sex, vital signs, pre‐enrolment analgesia, or baseline pain intensity. In comparing pain intensity during the study period, NRS scores at 30, 60 and 120 minutes were significantly lower in the ESPB group (p < 0.001) during rest and deep inspiration. Moreover, patients in the ESPB group received lesser rescue analgesia than those in the sham group (10 mg, IQR = 2.5 vs 20 mg, IQR = 5 mg; p = <0.01). There was no difference in adverse events between groups.ConclusionsUltrasound‐guided ESPB resulted in significantly reduced pain intensity over the study period, reduced amount of rescue analgesia, and had no discernible difference in adverse events when compared with a sham.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of ultrasound‐guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial

Ramesh,

Ayyan,

Rath

et al. 2023

Academic Emergency Medicine

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“…Nerve blocks develop into a critical component of emergency management of such injuries leading to better patient outcomes and patient satisfaction with analgesia. The Erector spinae block has already been shown to be effective in terms of analgesia for fractures of the posterior ribs and fractures of transverse processes of the vertebrae as shown by previous studies involving authors in this book [59].…”

Section: Injuries To the Chest Wall And Nerve Blocksmentioning

confidence: 54%

Pain Management in the Emergency Department – Newer Modalities and Current Perspective

Yadav¹,

Ajayababu²,

Sinha³

et al. 2024

Pain Management - From Acute to Chronic and Beyond

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Pain is one of the most common complaints and yet one of the most neglected aspects of management in the emergency department. Optimal pain management is a nuanced skill which focusses on reduction of pain to an acceptable level to allow for safe discharge and return to normal activities, in addition to improving patient satisfaction and comfort during their stay in hospital. Adequate analgesia also improves physiological parameters such as heart rate and blood pressure. The aim is improving rather than eradication of pain altogether while maintaining an acceptable level of adverse effects. This chapter will discuss assessment of pain in the emergency department along with various modalities of pain management with specific focus on newer modalities including ultrasound guided regional nerve blocks. Ultrasound guided nerve blocks are associated with better analgesia and have fewer chances of drug related adverse events, especially in older patients and those with comorbidities where large doses of systemic medications are associated with a significant risk of adverse effects.

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“…3 Bilateral ESPB has since been used in a variety of clinical cases, including as a part of multimodal analgesia following thoracic and cardiovascular surgeries, or for chronic low-back pain, vertebral fractures, acute pancreatitis, and rib fractures. [4][5][6] Risks of the procedure include pneumothorax, nerve injury, and local anesthesia toxicity. However, few complications of ESPB have been published.…”

Section: Mount Sinai Medical Center Department Of Emergency Medicine ...mentioning

confidence: 99%

Bilateral Erector Spinae Plane Block for Man o’ War Stings: A Case Report

Weber

Shalaby

2023

Clinical Practice and Cases in Emergency Medicine

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Introduction: The Portuguese man o’ war, an aquatic invertebrate, is responsible for a large proportion of cnidarian stings worldwide. Cnidaria is a phylum that contains the genus Physalia. These injuries result in severe pain and skin irritation, which are often difficult to control. Traditionally, cnidarian stings have been treated by emergency physicians with warm water, vinegar and, in severe cases, opioids. However, no concrete guidelines have been established for pain management in man o’ war stings. Case Report: Regional anesthesia (RA) is an increasingly used method of pain control in the emergency department. In the case of a 41-year-old female experiencing severe pain from a Portuguese man o’ war sting, RA with an erector spinae plane block (ESPB) provided her with rapid and long-lasting pain relief. Conclusion: The standard of care has yet to be defined when managing pain from Physalia physalis stings. Although this is the first documented use of ESPB for treatment of cnidarian stings, RA should be considered by any emergency physician when treating injuries caused by a Portuguese man o’ war.

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Erector spinae plane block for multiple rib fracture done by an Emergency Physician: A case series

Cited by 16 publications

References 16 publications

Efficacy and safety of ultrasound‐guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial

Efficacy and safety of ultrasound‐guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial

Pain Management in the Emergency Department – Newer Modalities and Current Perspective

Bilateral Erector Spinae Plane Block for Man o’ War Stings: A Case Report

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