Utility of ultrasound-guided erector spinae plane block in patients presenting to the emergency department with rib fractures

Abstract

Context: Alleviating significant pain and enhancing lung function in patients with multiple rib fractures presents a formidable challenge to all emergency physicians (EPs). Conventional pharmacological measures and traditional thoracic regional analgesia techniques are not always feasible or safe in the emergency department (ED). Therefore, an effective, feasible, and safe method for providing analgesia in such patients will be extremely advantageous to all patients and EPs alike. Here, we describe the utility of a regional block technique that can be applied in patients suffering from multiple rib fractures in the ED. Aims: The aims of this study were as follows: (1) to determine the effectiveness of an ultrasound-guided erector spinae plane block (ESPB) in ameliorating pain and improving lung function in patients presenting to the ED with multiple rib fractures and (2) to assess the safety and the feasibility of the ESPB in the ED. Setting and Design: This was a retrospective observational clinical study conducted in the ED of a tertiary care hospital over a period of 12 months. Subjects and Methods: Data regarding all patients with rib fractures who had undergone an ESPB in the ED were extracted from the ED procedure register, and the inpatient case sheets were obtained from the medical records department for review and analysis. The data included, but were not limited to, the Numerical Rating Scale (NRS) for pain and respiratory parameters, i.e., respiratory rate and peak expiratory flow rate (PEFR) at 30 min post procedure and subsequently after every top-up dose up to a period of 48 h. Statistical Analysis: Descriptive statistics such as mean, standard deviation, frequency, and percentage were used. Inferential statistics such as repeated-measures ANOVA were done using SPSS software version 22 (IBM). Results: The mean NRS was significantly reduced by >50% at 30 min and by 72% over a 48-h period (P < 0.001). Meaningful improvements in the respiratory parameters were also observed during the same period with significant increments in the PEFR values (49% increase [P < 0.001]) as well as a decrease of 36% in the respiratory rate (P < 0.001). The mean time for performing the procedure was 16.27 min, and no adverse events were observed as a consequence of the block. Conclusion: The study demonstrates the efficacy of USG-guided ESPB in ameliorating pain as well as improving lung function for multiple rib fracture patients. This procedure can be performed in a short time making it suitable for application in the ED. No adverse events as a consequence of the ESPB were noted.