Background and Aims The incidence of rib fractures has increased by 43.7% 1990 to 4.11 million in 2019. Hypoperfusion due to pain and damaged lung tissue as a result of rib fractures leads to respiratory complications such as pneumonia which is associated with increased mortality. The aims of this review are to compare to other regional anaesthetic techniques and draw conclusions from the data on the effectiveness of the ESPB at reducing respiratory complications.
Methods A literature search was conducted using PubMed and Scopus databases. The search yielded 433 results with 45 duplicates. The titles and abstracts of 388 records were screened for relevance, leaving 52 records. Application of the inclusion and exclusion criteria resulted in 8 studies to be included. A ‘snowball’ search was carried out which yielded no relevant papers.
Results 4 studies reported a significant reduction in pain and OME with ESPB compared to baseline however, only 1 study reported a significant difference between ESPB and the comparative analgesia (SAB). No significant difference was found for respiratory complications between ESPB and SAB or opioid analgesia however there was a significant increase in complications when ESPB was given after 48hrs compared to before. Similarly, diaphragmatic activity improved significantly with ESPB compared to SAB. Finally, there was no significant reduction in hospital or ICU length of stay.
Conclusions Despite appearing to be safe and giving significant improvements in pain and OME consumption, the links between ESPB and directly improved respiratory outcomes are tenuous. This demonstrates the need for further robust clinical trials with suitable outcomes.
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