Background and aims Traumatic rib fractures are painful. Inadequate pain control would impair breathing, adequate coughing with clearance of pulmonary secretions and compliance with chest physiotherapy. Consequently, patient is at risk of secondary pulmonary complications, i.e. atelectasis, pneumonia, respiratory failure, and the need for respiratory support. Multimodal analgesia with opioid has been the mainstay of pain management. Analgesic adjuncts like thoracic epidural, paravertebral or intercostal blocks are advocated. A novel regional technique — erector spinae plane (ESP) block — seems to provide effective analgesia and is easier to perform.
Methods All five patients gave written informed consent for reporting.
Results Patients were males with ASA physical status class III (except for one patient with ASA class II). The median age (interquartile range) was 55 (34.5–60) years and median BMI (IQR) was 34.5 (28.4–36.6) kgm-2. All had sustained multilevel rib fractures with lung injury requiring close monitoring in intensive care unit (ICU) and non-invasive ventilatory support.
Patients had received multimodal analgesia (paracetamol, tramadol, celebrex) plus PCA morphine with high 24-hour morphine consumption, mean (SD) were 49.6 (±18.7) mg. Despite high morphine usage, patients were still in severe pain and unable to perform chest physiotherapy. ESP block was delivered using ultrasound guidance catheter technique at the most painful site. Patients’ opioid requirement reduced significantly next few days, respiratory function improved and they only required oxygen via nasal cannula upon discharge from ICU. The median ICU stay was 5 days.
Conclusions ESP block with catheter is a promising and effective regional technique in managing painful rib fractures.
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