Abstract
The aim of the study: to improve the efficacy of erector spinae plane (ESP) fascial block for pain management in patients with multiple rib fractures. Materials and methods. We observed 4 patients with multiple rib fractures who were treated with ESP fascial block with subsequent prolonged administration of local anesthetic for pain relief. To evaluate the efficacy of the ESP block, the visual analogue scale (VAS) for pain intensity, cough performance index and forced vital capacity (FVC), as well as a modified 3-item scale were used. The distribution of local anesthetic (10% lidocaine solution) and contrast (iohexol solution, 350 mg iodine/ml) media was analyzed by computed tomography and correlated with the data on reduced pain perception according to the thoracic vertebrae (Th) levels.Results. After the ESP block in patients with multiple rib fractures, we found a decrease in VAS pain intensity at rest by 3-4 points and on coughing by 3-6 points, an increase in cough performance by 1 point and in the modified 3-item scale by 1-3 points. The distribution of the local anesthetic solution was registered mainly in the cranial-caudal and anterior direction to the intertransversal space without significant leakage in lateral and medial directions. In all 4 cases the local anesthetic and contrast media spread from the catheter tip cranially several levels of thoracic vertebrae farther than in caudal direction.Conclusion. ESP block in patients with multiple rib fractures is a reasonably effective method of pain relief. Catheterization of the fascial plane of erector spinae muscle should be performed at the level of vertebra corresponding to the underlying fractured rib. The data obtained may serve as a basis for further studies with more patients included.
Highlights
We noted a decrease in pain intensity by VAS both at rest and on coughing in an hour after the erector spinae plane (ESP) fascial block (Table 2)
In one of the first descriptions of the block made by Hamilton et al [6], a patient with multiple rib fractures and numerical rating score (NRS) of pain 6 out of 10 at rest and 10 out 10 on movements, had these scores reduced to 0 and 1, respectively, after the procedure
A retrospective cohort study by Adhikari et al corresponding to these data reported 79 patients with multiple rib fractures who exhibited ESP fascial block[15]
Summary
Впервые опубликовали данные о применении новой методики аналгезии грудной клетки, дав ей название «Erector Spine Plane block» [1]. На сегодняшний день фасциальная блокада МВС применяется как метод обезболивания не только грудной клетки, но и всего туловища [2,3,4,5]. Эта методика показана не только для достаточно эффективного обезболивания пациентов со множественными переломами ребер [6], но и как альтернатива эпидуральной и паравертебральной блокаде [7, 8]. Одни исследователи отмечают прохождение раствора красителя или контраста к вентральным ветвям и корешкам спинальных нервов [1, 9], тогда как Иванусик с соавт. Показывают, что распространения красителя к вентральным ветвям спинальных нервов не происходит [10] Одни исследователи отмечают прохождение раствора красителя или контраста к вентральным ветвям и корешкам спинальных нервов [1, 9], тогда как Иванусик с соавт. показывают, что распространения красителя к вентральным ветвям спинальных нервов не происходит [10]
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