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#36291 Continuous erector spinae plane block and catheter insertion for rib fracture pain in a peripartum patient: a case report and review of the literature
  1. Shane Kelly,
  2. Jesse Connors and
  3. Ryan Howle
  1. Dept. of Anaesthesiology, The Coombe Hospital, Dublin, Ireland


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Background and Aims The Erector Spinae Plane (ESP) block is paraspinal fascial plane block that targets both ventral and dorsal rami of the thoracic and abdominal spinal nerves. It has been used to provide analgesia for a range of surgical procedures and painful conditions. Spontaneous cough-induced rib fractures are a rare but recognised phenomenon in term parturients. Patients who experience rib fractures near term often undergo elective caesarean delivery, due to the recognition that thoracic pain may limit patient effort in the second stage of labour. We present a case of ESP catheter managed rib fracture pain, facilitating labour and vaginal delivery in a term parturient with a cough-induced rib fracture.

Methods A 38-year-old woman, para 1, presented at 37+6 weeks gestation with left-sided pleuritic chest pain, following a lower respiratory tract infection, which was associated with intense bouts of coughing. The presumptive diagnosis was an atraumatic rib fracture and she was initially discharged with analgesia. She re-presented the following day with 10/10 pain despite paracetamol, oxycodone and a lidocaine patch. A mid-thoracic ESP catheter was inserted under ultrasound guidance with immediate relief. She received 4-hourly clinician administered boluses of 20ml of 0.125% levobupivacaine for 5 days with a maximum pain score of 4 on coughing.

Results With adequate analgesia attained and following multi-disciplinary input, she underwent induction of labour, resulting in an instrumental vaginal delivery undercombined ESP and epidural analgesia.

Conclusions ESP blocks could be considered for pregnant patients presenting with rib fracture pain near term, who wish to attempt labour and vaginal delivery.

  • Obstetrics
  • Rib Fracture
  • Peripheral Nerve Block

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