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Background and Aims Rib fractures occur commonly in polytrauma patients and close to one third develop secondary pulmonary complications. This study aims to compare the analgesic efficacy between ultrasound guided erector spinae (ESP) versus paravertebral block (PVB)

Methods A retrospective analysis of patients with rib fractures that presented to our institution from 2020 to 2023 who either underwent ESP or PVB block was performed. Basic demographics, VAS pain scores before and after intervention, presence of sensory block and potential complications were collected.

Results We analysed 14 patients which consisted of 12 males and 2 females who had a median and average age of 47.0 and 50.1 years old respectively. On average, 5 ribs were fractured and there were 6 ESP and 8 PVB blocks performed. For patients who underwent ESP block, there was a decrease in VAS scores from 7.6 ± 1.1 to 4.0 ± 1.5, p < 0.018. For PVB block, there was a decrease in VAS scores from 5.3 ± 0.8 to 2.8 ± 0.2, p < 0.009. Investigating the presence of a sensory block, PVB demonstrated superiority in producing a sensory block in 87.5% and ESP in 50% of cases. However, there was 1 PVB block that required conversion to epidural and another patient who underwent ESP that needed supplemental PCA fentanyl.

Conclusions Both techniques were effective in reducing pain scores but PVB block demonstrated a trend towards lower pain scores, albeit without statistical significance. PVB group had superiority in producing a dermatomal sensory block.