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Background and Aims Rib fractures are common in polytrauma patients and require effective analgesia to prevent respiratory complications. Optimal pain management requires multimodal approach including regional anesthesia. Ultrasound-guided erector spinae plane block (ESPB) with catheter placement allows good pain control, improves respiratory outcomes and has negligible risk. Our aim was to present a case series of 11 patients with multiple rib fractures whom thoracic ESPB with catheter placement was performed for analgesia.

Methods We present a case series of 11 patients, between 41-80 y-old and mostly ASA II whom thoracic ESPB was performed for pain management. All patients were referred to the acute pain unit due to uncontrolled pain and/or worsening respiratory function. Thoracic ESPB with catheter placement was performed and an analgesic regimen such as PCA (infusion and/or bolus) or PIEB was applied.

Results The number of broken ribs varied from 5-10, and in one of the cases the patient had bilateral rib fractures. Four received non-invasive ventilation and 2 mechanical invasive ventilation. Six of them had pulmonary contusion, 3 evolved to pulmonary infection. Nine patients were under PCA (infusion and/or bolus) and 2 patients under PIEB regimen. In all patients ropivacaine 0,2% was the chosen local anesthetic. In all cases there was an improvement in pain scores 24h after ESPB. The mean PaO2/FiO2 ratio was higher in all patients 24h after catheter placement.

Conclusions Further investigation on ESPB with catheter placement should be made as it may be an alternative to epidural or thoracic paravertebral block in patients with multiple rib fractures.