79 Efficacy of the Ultrasound Guided Bilateral Erector Spinae Plane Block in Treating Traumatic Thoracic Pain

Abstract

Patients presenting to the emergency department (ED) with traumatic thoracic injuries are often in severe pain and are at high risk of developing respiratory complications secondary to decreased tidal volumes and opioid administration. The erector spinae plane block (ESPB) is a regional anesthesia technique previously described for perioperative and chronic pain. Our objective is to describe the novel use and efficacy of the bilateral ultrasound guided ESPB (and associated catheter placement) performed by emergency physicians for the treatment of acute traumatic thoracic pain. We performed a retrospective case series review of nine patients presenting to the ED in a five-month period between July and November 2019. All presented with bilateral thoracic trauma and had bilateral ESPBs placed by emergency physicians with simultaneous placement of catheters for continuous regional analgesia. We reviewed the medical record for each patient including data regarding opioid use, subjective pain scores and complications of the procedure. Opioid use was standardized by converting all opioids given to a patient (excluding those given for procedures such as catheterization) into the morphine milligram equivalent (MME). Mann-Whitney testing was used to compare the MME per day (MMED) used by patients with the ESPB catheter in place and days without the catheter. The average age of patients was 62.8 years of age including five males and four females. Six patients had trauma from falls or motor vehicle collisions and three had injuries from chest compressions. All patients had at least two rib fractures on each thoracic side with a mean total of 10.4 rib fractures per patient. All patients received an initial bolus of ropivacaine and a subsequent infusion ranging from 10 to 14 milliliters per hour. The average duration of the catheters was 6.9 days. The median MMED without the ESPB catheter was 47.0 mg/day (IQR 26.7-100) compared to 18.5 mg/day (IQR 5-41.1) with the catheter (p = 0.056). All patients had decreased opioid use with catheter placement except one patient who did not receive any opioids at all. All patients reported subjective improvement in pain with catheter placement. No complications such as infection, hemorrhage, pneumothorax, or local anesthetic toxicity were found. The bilateral ultrasound guided ESPB is an effective treatment for acute traumatic thoracic pain and can be performed safely by emergency physicians.