Neuraxial Blockade Research Articles

Comparing the efficacy of tramadol, ketamine and dexmedetomidine in the prevention of intraoperative shivering in patients undergoing surgery under subarachnoid blockade

The most common nagging and inconveniencing complication of spinal anesthesia is intra operative shivering. Central neuraxial blockade blunts the thermoregulatory mechanism by restricting vasoconstriction, resulting in shifting of central heat to the periphery from the trunk. Various pharmacological and non pharmacological methods are used for the control of intraoperative shivering.The aim of our study was to compare the efficacy of Tramadol, Ketamine and Dexmedetomidine in the prevention of intra operative shivering in patients undergoing surgeries under subarachnoid blockade.90 patients of age group between 20 to 65 years belonging to ASA 1 and 2 posted for elective surgery under spinal anaesthesia will participate in this study. The patients were randomly allocated into 3 groups of 30 each and were named as by computer generated random table number. Group T received Tramadol 0.5 mg/kg in 100 ml NS over 10 – 15 minsGroup K Ketamine 0.25 mg/kg in 100 ml NS over 10 – 15 mins and Group D Dexmedetomidine 0.5 μg/kg in 100 ml NS over 10 – 15 mins.Data were statistically analysed with the SPSS version 22.0 software using two-sided unpaired t-test and Chi-square test. A repeated measure of ANOVA was applied for the three groups to know the with-in subject variability in prevention of shivering following subarachnoid blockade and p value < 0.05 was considered to be significant.The conclusion of our study is that Dexmedetomidine at the dose of 0.5 μg/kg decreases effectively in the prevention of intra operative shivering in patients undergoing surgery under subarachnoid blockade when compared with Tramadol and Ketamine.

Above knee amputation in a geriatric patient with severe ICMP and DM2: A case report

Geriatric patients with cardiac dysfunction are always a nightmare for anaesthetist in terms of successful intraoperative and postoperative management. We are presenting a case of 68-year-old male patient admitted in surgical emergency with rapidly progressive wet gangrene of right leg. He was a diagnosed case of severe Ischemic cardiomyopathy (ICMP) and Diabetes mellitus type 2 (DM-2) since last 10 years on medications. However, he was non-compliant with medications and had developed severe limitation in the functional status with metabolic equivalents <4 (METs<4) and complaints of chest pain even on minimal exertion. In view of the rapidly progressive wet gangrene and risk of sepsis leading to high possibility of morbidity and mortality, an urgent above knee amputation was planned. However due to the risks associated with general anaesthesia and central neuraxial blockade, an safe anesthesia plan was formulated and implemented utilising only the lower limb blocks to achieve a safe conduct of anaesthesia.

Reinvestigation on Newer Facts to Anticipate, Avoid And Mitigate The Development of Post-Dural Puncture Headache-A Prospective Cohort Study

Purpose: Various researchers have described the size and the type of spinal needle used for neuraxial anesthesia as the most common risk factor for developing postdural puncture headache (PDPH). Even though the occurrence of the PDPH is rare in modern anesthesia practice, we come across many such patients despite following all guidelines or precautions. Patient-related factors for developing PDPH are relatively understudied. For that, clinical features commonly present in such patients may require a thorough investigation. Methods: This prospective cohort study included fifty patients admitted for lower extremities orthopedic surgeries and developed PDPH following the neuraxial blockade. We screened all patients in this study for the presence or absence of common manifestations suggestive of connective tissue disorders (CTD). The other outcomes, like the effect of spinal needle size/type to develop PDPH and time to develop PDPH, were also measured. Results: Almost all PDPH patients included in this study had common features suggestive of CTD: the ligamentous laxity (96%), high-arched palate (96%), the blue sclera (45%), joint hyperextensibility (82%), and ejection clicks (64%). PDPH occurred more frequently with the 25G spinal needle of Quincke type than 27G of Whitacre type (82% vs. 18%). The mean (SD) headache freedom time was 73.14 (24.74) hours. Conclusions: The CTD might also be a causative factor responsible for the development of PDPH in some individuals. It can be considered a risk factor to anticipate, avoid, and mitigate the development of PDPH.

Ultrasound Assisted Neuraxial Blockade in Obstetric Anesthesia

Central Neuraxial Blocks (CNBs) relevant to the practice of obstetric anesthesia and analgesia are spinal, epidural and combined spinal-epidural injections. These techniques are routinely used for cesarean deliveries and labor pain relief. Traditionally, CNBs are performed using surface anatomical landmarks. In the first instance the highest point of each iliac crest is identifies. The imaginary line connecting these points allegedly passes through the L4 vertebral body in non-pregnant women, and L3 vertebral body in pregnant women [1]. Based on this, the operator palpates and counts the spinous processes and decides on the needle entry point. Although this technique is widely accepted as relatively reliable, the correlation is inconsistent even in non-complicated cases. Obesity, tissue edema, pelvic rotation, limited ability to bend forward, hyperlordosis, labor pain, underlying spinal deformity or previous back surgery and instrumentation pose additional difficulty for anesthesiologists to correctly locate the intervertebral levels.

Multimodal opioid sparing onco-anesthesia: A consensus practice guideline from Society of Onco-Anesthesia and Perioperative Care (SOAPC).

Opioids are an indispensable part of perioperative pain management of cancer surgeries. Opioids do have some side effects and abuse potential, and some laboratory data suggest a possible association of cancer recurrence with perioperative opioid use. Opioid-free anesthesia and opioid-sparing anesthesia are emerging new concepts worldwide to safeguard patients from adverse effects of opioids and potential abuse. Opioid-free anesthesia could lead to ineffective pain management, leaving the perioperative physician with limited options, while opioid-sparing anesthesia may be a rational approach. This consensus guideline includes general considerations of the safe use of perioperative opioids along with concomitant use of central neuraxial or regional blockade and systematic nonopioid analgesics. Region-specific onco-surgeries with their specific recommendations and consensus statements for judicious use of opioids are suggested. Use of epidural analgesia or regional catheter during thoracic, abdominal, pelvic, and lower limb surgeries and use of regional nerve blocks/catheter in head neck, neuro, and upper limb onco-surgeries, wherever possible along with nonopioids analgesics, are suggested. Short-acting opioids in small aliquots may be allowed to control breakthrough pain for expedient control of pain. The purpose of this consensus practice guideline is to provide the practicing anesthesiologists with best practice evidence and consensus recommendations by the expert committee of the Society of Onco-Anesthesia and Perioperative Care for safe opioid use in onco-surgeries.

Major neurological complications following central neuraxial blockade – A multicentre pilot study in Aurangabad city (MGMA CNB Study)

Background and Aims:Incidence of major neurological complications following central neuraxial blockade (CNB) in India is not known. This information is essential for explaining risk preoperatively to patients and for medico-legal purposes. This study was undertaken to assess feasibility (recruitment process, protocol adherence, resources mobilisation, data management and evaluation of scientific outcome) for planning multicentric studies on major neurological complications following CNB at state/national level.Methods:This was a hospital-based, multicentre pilot study, with cross-sectional and follow-up components. Patients receiving CNB either perioperatively or during acute/chronic pain management were included in the study. Thirty-six randomly selected tertiary and nontertiary care institutes were included. Details of demographic information, CNB procedure and major neurological complications were collected anonymously via online tools. Feedback about study feasibility was collected from participating anaesthesiologists and study team.Results:Selected institutes continued participation throughout study period. About 99.98% of eligible patients were enroled. Complete data collection of 8053 patients and analysis was possible. Regular reminders from study coordinators helped to optimise data collection. Tertiary care institutes contributed to 74.50% of data. About 64.96% patients were females. Spinal anaesthesia was the most frequently used neuraxial block (93.41%). Bupivacaine and adjuvant were used in 95.53% and 16.5% patients, respectively. Two patients developed cardiac arrest and cause-effect relationship with CNB was established. Participants’ recruitment, protocol adherence, resources mobilisation, data management and evaluation of scientific outcomes were feasible.Conclusion:A multicentre state/nationwide study can be conducted based on this first-of-its-kind pilot study in India.

What's New in Neuraxial Labor Analgesia.

Purpose of ReviewThis article provides an update of recent practice trends in neuraxial labor analgesia. It reviews available evidence regarding management of labor pain in obstetric patients with COVID-19, serious adverse events in obstetric anesthesia to help inform risk/benefit decisions, and increasingly popular neuraxial labor analgesia techniques and adjuvants. State-of-the-art modes of epidural drug delivery are also discussed.Recent FindingsThere has recently been a focus on several considerations specific to obstetric anesthesia, such as anesthetic management of obstetric patients with COVID-19, platelet thresholds for the safe performance of neuraxial analgesia in obstetric patients with thrombocytopenia, and drug delivery modes for initiation and maintenance of neuraxial labor analgesia.SummaryNeuraxial labor analgesia (via standard epidural, dural puncture epidural, and combined spinal epidural techniques) is the most effective therapy to alleviate the pain of childbirth. SARS-CoV-2 infection is not, in and of itself, a contraindication to neuraxial labor analgesia or cesarean delivery anesthesia. Early initiation of neuraxial labor analgesia in patients with COVID-19 is recommended if not otherwise contraindicated, as it may reduce the need for general anesthesia should emergency cesarean delivery become necessary. Consensus regarding platelet thresholds for safe initiation of neuraxial procedures has historically been lacking. Recent studies have concluded that the risk of spinal epidural hematoma formation after neuraxial procedures is likely low at or above an imprecise range of platelet count of 70–75,000 × 106/L. Thrombocytopenia has been reported in obstetric patients with COVID-19, but severe thrombocytopenia precluding initiation of neuraxial anesthesia is extremely rare. High neuraxial blockade has emerged as one of the most common serious complications of neuraxial analgesia and anesthesia in obstetric patients. Growing awareness of factors that contribute to failed conversion of epidural labor analgesia to cesarean delivery anesthesia may help avoid the risks associated with performance of repeat neuraxial techniques and induction of general anesthesia after failed epidural blockade. Dural puncture techniques to alleviate the pain of childbirth continue to become more popular, as do adjuvant drugs to enhance or prolong neuraxial analgesia. Novel techniques for epidural drug delivery have become more widely disseminated.

Regional tissue oxygen saturation as a predictor of post-spinal anesthesia hypotension for cesarean delivery.

Regional tissue oxygen saturation as a predictor of post-spinal anesthesia hypotension for cesarean delivery.

Ultrasound-guided lumbar ESP block for post-operative analgesia as an alternative mode of analgesia in hip arthroplasty with multiple systemic issues: a case report

BackgroundPatients with multiple systemic diseases present an anaesthetic challenge in terms of perioperative pain management. We propose that ultrasound-guided erector spinae plane block be used as an alternative mode of analgesia in patients undergoing hip arthroplasty.Case presentationWe report a case of a 54-year-old female, a known case of autosomal dominant polycystic kidney disease on continuous ambulatory peritoneal dialysis, hypertension, and deranged coagulation profile with fractured neck of femur planned for hemiarthroplasty. She was administered ultrasound-guided single-shot erector spinae plane block at L3 level with 20 mL of 0.25% ropivacaine and 4 mg dexamethasone. This block provided excellent post-operative analgesia for up to 24 h with early mobilisation.ConclusionSingle-shot ultrasound-guided erector spinae plane bock can be used as an alternative mode of analgesia in patients undergoing hip arthroplasty, with multiple systemic diseases in whom neuraxial blockade cannot be performed. This technique needs to be further explored in the form of randomised controlled trials.

Difficult subarachnoid anaesthesia Prediction and Performance

Spinal anaesthesia (SA) has enjoyed a long history of success, celebrating soon its 125th anniversary. Puncturing the dura mater is considered a simple procedure, followed by a subarachnoid injection of a local anaesthetic (LA) agent into the cerebrospinal fluid (CSF). Even when the technique is performed perfectly, there is no guarantee that the block sits perfectly. Failure is not uncommon and encompasses a range from total absence of any neuraxial blockade, a partial block (insufficient height, quality or duration) or a patchy block. Table 1 lists a large number of potential causative factors that may result in a failed spinal anaesthetic, providing suggestions of solutions. Analysing each distinct phase of the procedure, i.e., spinal puncture, injection of local anaesthetic solution, spread of the local anaesthetic solution through the cerebrospinal fluid, action of the drug on subarachnoid neural tissue and patient management, are the keys to success at each stage. Mechanisms of failure of spinal anaesthesia include insufficient preparation and check of equipment and drugs, suboptimal positioning of the patient, unsuccessful puncture due to inadequate training or experience and inadequate use of needles and local anaesthetic solution.1-5 Besides operator, preparation, technique-dependent and patient-related factors (anatomical variations), there are also organisational factors (lack of block room, lack of adequate monitoring and trained personnel, insufficient time between block and onset of surgery, subsequent management following block). The use of the correct local anaesthetic (dose, volume, concentration) injected at the correct lumbar interspace is of paramount importance to produce an adequate spinal block for the right surgical intervention. Nevertheless, failures may still occur. Therefore, the anaesthetist should always have a contingency plan for a failed spinal block. Indeed, patients expect reliable surgical anaesthesia when undergoing an operation

Sekar’s DISH10 (Deep Inspiration, Squeeze & Hold for 10 seconds) Maneuver- A Novel, Non-invasive and Cost-effective Treatment for Postdural Puncture Headache – A Comparative Cohort Study

Postdural puncture headache (PDPH) is one of the iatrogenic complications of the neuraxial blockade. Its incidence has steadily declined with advances in anesthesia techniques, improved knowledge of pathophysiology, and the implementation of preventable measures.

A COMPARISON OF LEFT UTERINE DISPLACEMENT USING CLINOMETER GUIDED TABLE TILT VS CONVENTIONAL CRAWFORD WEDGE DURING SPINAL ANAESTHESIA IN CESAREAN SECTION- A PROSPECTIVE RANDOMIZED STUDY

INTRODUCTION: Enlarged gravid uterus causing aortocaval compression may decrease the venous return and cause maternal hypotension. Maternal position after neuraxial blockade may exacerbate the impact of aortocaval compression and consequences on cardiovascular instability. Left uterine displacement (LUD) after spinal anaesthesia in lower segment cesarean section is essential in preventing supine hypotension syndrome. Decreased cardiac output secondary to vena cava obstruction by the gravid uterus can be prevented by lateral tilt position. AIM OF THE STUDY: This study is therefore designed to evaluate the role of leftward uterine displacement by table tilt using clinometer software or by using crawford wedge tilt and compare the effects on hemodynamics in parturient undergoing lower segment cesarean section (LSCS) under subarachnoid block MATERIALS AND METHODS: The study was carried out in the Department of Anaesthesiology involving Department of Obstetrics and gynecology in Kanyakumari Government Medical College from January 2018 to June 2019. Patients were allocated into two groups by randomization. After spinal anaesthesia parturient in Group T: Lateral Table Tilt by using clinometer -15 degree- (40 parturient). Parturient in Group W: Crawford wedge Tilt- (40 parturient). Patients, age, body weight, BMI and baseline vital parameters were recorded. Incidence of hypotension after spinal anaesthesia in a cesarean section, Total dose Vasopressor required, Level of blockade, APGAR Score, Surgeon satisfaction grading. RESULTS: The demographic parameters like age, height, weight, BMI and the indication for surgery were similar in both groups. There were no difference in mean height level of block between both groups. In comparison of hypotensive incidence in both groups, the high incidence noted in the GROUP W (wedge group) (35%) is higher than the incidence in GROUP T (table tilt) nd th th (7.5%). The incidence of hypotension is signicantly noted at 2 , 4 , 5 minute after the subarachnoid block in wedge group compared to the table tilt group. The dose of vasopressor requirements and average ephedrine dose used is less in GROUP T (table tilt) (0.6±2.3mg) compared to GROUP W (wedge) (3.9±5.7 mg). In comparison of surgeon satisfaction between both groups, surgeons are much satised with the wedge group patient and found difcult, disturbing and sometimes unbearable st th while perform the surgery for the patient in table tilt. The APGAR Scores in GROUP W at 1 minute and 5 minute is (7.3±0.5 and st th 8.7 ±0.5) respectively which are relatively satisfactory compared to the GROUP T (6.8±0.6 and 8.3±0.6) at 1 and 5 minute. CONCLUSION: Table tilt provide a good relief from inferior vena cava and aortocaval compression when compared to the wedge placed under the right hip during cesarean section done under subarachnoid block. Using the wedge is easier and 0 surgeons at our institute found it more comfortable than the table tilt to 15 but anesthetists feel better with table tilt because there is little incidence of hemodynamic variation. We conclude that all the parturient posted for caesarean section should be 0 given a table tilt of 15 placed with angle measured exactly by clinometer to decrease incidence of hypotension occurring due to aortocaval compression

P.32 Intrathecal anaesthetic drug dosing strategies for repair of perineal tears: An evaluation of current practice

Introduction: Spinal anaesthesia is the method of choice for obstetric procedures due to avoidance of the additional risks posed by general anaesthesia to the obstetric population. [1] Bloom SL, Spong CY, Weiner SJ, et al. Complications of anesthesia for cesarean delivery. Obstet Gynecol 2005;106:281–7. Google Scholar Excessive intrathecal dosage during neuraxial blockade is associated with greater incidence of side effects, [2] Van de Velde M, Van Schoubroeck D, Jani J, et al. Combined spinal- epidural anesthesia for cesarean delivery: dose-dependent effects of hyperbaric bupivacaine on maternal hemodynamics. Anesth Analg 2006;103:187–90. Google Scholar including hypotension, nausea and vomiting and an increased length of time to recovery from anaesthesia [3] Nair GS, Abrishami A, Lermitte J, Chung F. Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy. Br J Anaesth 2009:307–15. Google Scholar that may adversely affect breastfeeding, bonding with the child and overall maternal satisfaction. To date there is no literature supporting a standardised intrathecal dose for perineal tear repair and we sought to investigate the range of current practice.

P.126 Facial nerve palsy following accidental dural puncture

Introduction: Cranial nerve palsy is an infrequent complication of obstetric neuraxial blockade. We present a case of facial nerve palsy after accidental dural puncture in the absence of a classical post-dural puncture headache (PDPH).

P.136 All that fits isn’t eclampsia

Introduction: Intracranial subdural haematoma (ISH) due to inadvertent puncture of the spinal dura mater following central neuraxial blockade is exceedingly rare, with fewer than 100 cases reported. [1] Szeto V, Kosirog J, Eilbert W. Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature. Int J Emerg Med 2018; 11:36. Google Scholar In obstetrics, ISH secondary to epidural anaesthesia is around 1:500,000. [1] Szeto V, Kosirog J, Eilbert W. Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature. Int J Emerg Med 2018; 11:36. Google Scholar We present an obstetric case exemplifying these consequences, ultimately presenting with seizure, also revealing an undiagnosed cerebral structural abnormality.

Fluoroscopy comes to the rescue in anaesthesia management of a case of ankylosing spondylitis

Ankylosing spondylosis is always a challenge when patient has severe deformities to choose between general anaesthesia versus regional anaesthesia. Regional anaesthesia is always a choice either at institutionally or at smaller private hospital set ups. Schewley and colleagues compared regional versus general anaesthesia over 10 years and shown that regional anaesthesia is equally good choice.[1] There are many case reports which suggest that regional anaesthesia could be a safer option in severe Ankylosing spondylosis patients.[2] Author has managed to achieve neuraxial access by using fluoroscopy. However, interpretation of images by fluoroscopy could be difficult for anaesthetists without chronic pain management background. Also, availability of fluoroscopy could be variable as it may be busy in other theatres to be available later for surgery. Use of ultrasound to view spaces could be useful in cases with difficult neuraxial access to find the space. Most of the anaesthetists practising regional anaesthesia have expertise in using ultra-sound and also are comfortable to interpret the images. USG could also be helpful in pre-operative setting to identify and plan for central neuraxial blockade. [4] There are many case reports of use of USG guidance for neuraxial anaesthesia in such cases. [3] However, central neuraxial blocks in these patient comes with risks. The placement of epidural anaesthesia is technically difficult and is associated with an increased risk of an epidural haematoma. Wulf reported five out of 51 patients with spinal haematoma occurred in patients with AS in a comprehensive review of spinal haematoma associated with epidural anaesthesia over a 30?year period. These were related to difficult or traumatic insertion. In this his review article, he also mentions Ankylosing spondylosis as one of the risk factor for spinal or epidural haemoatoma. [5] Li et al also present a case report where patient developed epidural haematoma after epidura

Spinal Anesthesia Using Ropivacaine Leads to Earlier Ambulation After Total Hip Arthroplasty.

Spinal anesthesia has grown in popularity for total hip arthroplasty (THA) due to its documented low complications. However, the use of a local anesthetic agent dictates the recovery of neuraxial blockade. Bupivacaine has emerged as the most popular choice, but its relatively long-acting effect limits its use with rapid recovery. Although not well studied, ropivacaine may offer a viable alternative with shorter-acting properties. Primary unilateral THA patients who received either ropivacaine or bupivacaine spinal anesthesia were retrospectively reviewed. These groups were compared for common demographics, such as age, sex, and body mass index. The primary outcomes included postoperative ambulation time and distance, post-anesthesia care unit transition time, and selective complications. Five hundred three patients were included. Of these, 227 received ropivacaine and 276 received bupivacaine. The ropivacaine group showed superior ambulation time and distance, quicker post-anesthesia care unit transition, and equivalent complications compared with the bupivacaine group. Ropivacaine shows a clear advantage over bupivacaine for spinal anesthesia during THA when considering rapid recovery. Its use should be strongly considered, especially in the ambulatory setting. [Orthopedics. 2021;44(3):e343-e346.].

Effect of lumbar epidural blockade and propofol on mean arterial pressure, cardiac output and bispectral index: A randomised controlled and pharmacodynamic modelling study.

It is generally accepted that a neuraxial blockade strengthens the sedative effects of propofol. Deafferentation caused by neuraxial blockade is thought to play a key role. The objective is to determine whether epidural blockade affects the bispectral index (BIS) of propofol and two other pharmacodynamic endpoints, mean arterial pressure (MAP) and cardiac output (CO). Randomised, placebo-controlled study. University hospital. Patients scheduled for surgery needing epidural analgesia. 28 ASA one or two patients received 0, 50, 100 or 150 mg of epidural ropivacaine. After stabilisation of the epidural blockade, propofol was given by target-controlled infusion. The propofol plasma target concentrations were increased at 6-min intervals from 0 to 1, 2.5, 4 and 6 μg ml-1. The study was performed before surgery. Three endpoints, BIS, mean arterial blood pressure and CO were measured from baseline (prior to the administration of epidural ropivacaine) until 2 h after the start of propofol infusion. The propofol concentration-effect data were analysed to determine the interaction between epidural blockade and propofol sedation. In the absence of propofol, the increase in number of epidural blocked segments from 0 to 15.5 (range 6 to 21) reduced the MAP by 30%, without affecting BIS or CO. In the absence of epidural blockade, the increase in propofol concentration to 6 μg ml-1 reduced BIS, MAP and CO. When combined, epidural anaesthesia and intravenous propofol exhibited no pharmacodynamic interaction on any of the three endpoints. In addition, epidural blockade did not affect the propofol effect-site equilibration half-life for its haemodynamic effects (11.5 ± 0.5 min) or for its effects on the BIS (4.6 ± 0.4 min). Epidural blockade reduces the propofol requirements for sedative end points. This is not the result of a pharmacodynamic interaction. Dutch trial register CCMO, Central Committee on Research Involving Human Subjects, trial number NL 32295.058.10.

Avoid suboptimal perioperative analgesia during major surgery by enhancing thoracic epidural catheter placement and hemodynamic performance

Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention...

Safety of Erector Spinae Plane Blocks in Patients With Chest Wall Trauma on Venous Thromboembolism Prophylaxis

BackgroundCurrent guidelines for severe rib fractures recommend neuraxial blockade in addition to multimodal pain therapies. While the guidelines for venous thromboembolism prevention recommend chemoprophylaxis, these medications must be held for neuraxial blockade placement. Erector spinae plane block (ESPB) is a newly described block for thoracic pain control. Advantages include its quick learning curve and potential for less bleeding complications. We describe the use of ESPB for rib fractures in patients on chemoprophylaxis. We hypothesize that ESPB can be performed in this patient population without holding chemoprophylaxis. Materials and methodsThis was a retrospective observational cohort study of a level 1 trauma center from 9/2016 to 12/2018. All patients with trauma with rib fractures undergoing neuraxial blockade or ESPB were included. Demographics, chemoprophylaxis and anticoagulation regimens, outcomes, and complications were collected. ResultsNine hundred sixty-four patients with rib fracture(s) were admitted. Of these, 73 had a pain management consult. Thirteen had epidural catheters and 25 had ESPBs placed. There was no difference in demographics, injury patterns, bleeding complications, or venous thromboembolism rates among the groups. Patients with ESPB were less likely to have a dose of chemoprophylaxis held because of placement of a catheter (25% versus 100%, P < 0.00001). Three patients with ESPB were on oral anticoagulation on admission, and two were able to continue their regimen during placement. ConclusionsESPB can be safely placed in patients on chemoprophylaxis. It should be considered over traditional blocks in patients with blunt chest wall trauma because of its technical ease and ability to be performed with chemoprophylaxis.