Background and Aims Rib fractures cause significant pain and respiratory complications1. Common analgesic techniques include opiates and thoracic epidurals, both have significant side effects2. Erector spinae plane (ESP) block with catheter insertion has been used as an alternative due to its ability to provide analgesia with a potentially better side effect profile3, 4. We describe a case of a 74 year old gentleman with a significant smoking history and COPD who had suffered trauma and fractured ribs 8–11 on his right side.
Methods To perform the ESP block we injected local anaesthetic and then inserted a catheter between the erector spinae muscle and transverse processes (figure 1). A bolus dose of 30 ml 0.25% levobupivacaine was injected followed by infusion of bupivacaine 0.125% 10 ml/hr. This was later increased to 15 ml/hr due to some patient discomfort.
Results Prior to the ESP block the patient had required 44 PCA doses in 24 hrs, afterwards he required 10 doses in 24 hrs. Pain scores improved from a baseline level of 8/10 with episodes of 10/10 prior to block, to a baseline level of 0/10 with episodes of 2/10 afterwards. Prior to ESP block he was unable to use the incentive spirometer due to pain, the following day he was able to use the incentive spirometer without any pain (figure 2).
Conclusions The ESP block both reduced the patients pain symptoms and improved his respiratory function. The patient much preferred the ESP block to the PCA he had been using before. ESP block is a useful tool in the management of pain from rib fractures.
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