Background and aims Rib fracture pain is severe and traditionally treated with systemic analgesics or epidural block. Opiate analgesics and continuous epidural anaesthesia are commonly associated with side effects. Coagulation abnormalities may prevent catheter insertion. Ultrasound-guided (USG) erector spinae block (ESB) and catheter ESB (ESBC) have been shown to provide good analgesia for acute rib fracture pain.
Methods An 81-year-old woman fell from a height of 10 stairs. She sustained right-sided posterior lateral rib fractures (ribs 3–8), with a flail segment, and right-sided, moderate pneumothorax (requiring formal chest drainage). Other injuries included fracture of the transverse process of the 9th thoracic vertebrae and right shin degloving injury. She suffered from Parkinson’s dementia and the opiates required to alleviate the severe rib fracture pain were increasing her confusion and agitation.
Results A right-sided USG ESB was undertaken with 40 mls of 0.125% bupivacaine (1:400,000 Adrenaline) at T5 with good effect. Right USG ESBC was inserted to reduce ongoing opiate consumption. The ESBC was connected to a continuous infusion of 0.125% bupivacaine at a rate of 10 ml/hr. She was prescribed regular paracetamol for her other injuries. The ESBC infusion was used during her surgery for rib fracture fixation and in the post-operative period. She was comfortable on this infusion with no rest pain. She had some mild right shoulder pain during physiotherapy but required no further opiate medications. The ESBC was removed on the 3rd day post-operatively.
Conclusions ESBC infusion maybe a useful alternative to epidural infusion in patients with rib fractures requiring surgical rib fracture fixation to reduce opiate consumption.
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