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Background and Aims Rib fractures are common in trauma patients and require effective analgesia to prevent respiratory complications. Regional anaesthetic techniques, such as thoracic epidural or paravertebral block, are often the mainstay of treatment. In the erector spinae plane (ESP) block, by placing the local anesthetic deep to the erector spinae muscle and near the costotransverse foramina, we can achieve effective analgesia.
Methods We report a case of a successful ESP block using a continuous technique for analgesia in a 60-year-old trauma patient who presented with multiple left-sided rib fractures from T3-T8. 24 hours post injury the patient complained of severe pain in the left hemithorax and was unable to take a deep breath or cough, despite optimized intravenous analgesia. With the patient in a right lateral decubitus position, a left-sided ultrasound-guided ESP block was conducted at the level of T6. A bolus of 30ml 0,2% ropivacaine produced almost immediate pain relief. An indwelling peripheral nerve block catheter was placed within the ESP under ultrasound guidance. The catheter was secured in place. A continuous infusion of 10 ml/h 0,2% ropivacaine with patient-controlled analgesia boluses of 5mL was initiated.
Results In the following days, the patient revealed lower pain scores and greater breathing ability. After 3 days the catheter was removed.
Conclusions Fascial plane blocks like the ESP block are technically easier to perform compared with neuraxial and targeted nerve blocks and have fewer serious side-effects. In our case, the presence of unilateral rib fractures made the ESP block an effective alternative to neuraxial or paravertebral procedures.
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