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Abstract
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Background and Aims Adequate pain control after blunt upper thoracic injuries such as sternal fracture and ribs fracture is deemed essential to improve patient’s overall outcome as often these injuries can impaired patient’s breathing, lead to atelectasis and impaired cough which may progress into respiratory failure. Thoracic epidural has been the gold standard analgesia for thoracic injury. However, newer techniques like erector spinae plane (ESP) block has been described which is simple and safe to perform. We present a case of high ESP block at T1 in pain management of sternal fracture and first rib fracture with sternoclavicular joint disruption.
Methods 32 years old gentleman sustained right 1st rib and sternum fracture with mild right hemothorax and lung contusion and dislocation of right sternoclavicular joint with posterior dislocation of medial end of clavicle after a high impact road traffic accident. Despite high doses of morphine given, pain scoring by visual analogue scale remain 8 on movement. Therefore, a single shot right erector spinae plane block at the level of transverse process T1 was done.
Chest X-Ray showing right first rib fracture and strenoclavicular disruption
Surface anatomy, label corresponding to transverse process
Ultrasound anatomy of Transverse process T1 and erector spinae muscle with local anaesthetic infiltration
Results After procedure, patient was able to lift up right arm and effectively carry out deep breathing exercise. Pain score was markedly reduced.
Conclusions ESP block is effective for managing pain secondary to sternal fracture with sternoclavicular joint dislocation and rib fractures. It can be implement as primary option for analgesia in such blunt thoracic injuries.