scholarly journals Erector Spinae Plane Fascial Block in Multiple Rib Fractures (Case Report)

2020 ◽  
Vol 16 (5) ◽  
pp. 22-29
Author(s):  
V. Kh. Sharipova ◽  
I. V. Fokin ◽  
F. K. Sattarova ◽  
F. O. Parpibayev
Keyword(s):  
Pain Relief ◽  
Pain Intensity ◽  
Local Anesthetic ◽  
Pain Perception ◽  
Rib Fractures ◽  
Erector Spinae ◽  
Thoracic Vertebrae ◽  
Multiple Rib Fractures ◽  
Catheter Tip ◽  
Item Scale

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.

scholarly journals Ultrasound-Guided Continuous Erector Spinae Plane Block in a Patient with Multiple Rib Fractures

2019 ◽  
Vol 47 (3) ◽  
pp. 235-237 ◽  
Author(s):  
Rakesh Kumar ◽  
◽  
Ankur Sharma ◽  
Rakhi Bansal ◽  
Manoj Kamal ◽  
...  
Keyword(s):  
Rib Fractures ◽  
Erector Spinae ◽  
Ultrasound Guided ◽  
Multiple Rib Fractures ◽  
Erector Spinae Plane Block

The Treatment of Rib Fractures

2020 ◽  
Vol 86 (9) ◽  
pp. 1144-1147
Author(s):  
Paige Farley ◽  
Parker R. Mullen ◽  
Catherine N. Taylor ◽  
Yannleei L. Lee ◽  
Charles C. Butts ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Injury Severity ◽  
Intercostal Nerve ◽  
Rib Fractures ◽  
Hospital Length Of Stay ◽  
Intercostal Nerve Block ◽  
Nerve Blocks ◽  
Multiple Rib Fractures

Background Rib fractures are a major problem characterized by pain, increased length of stay, and respiratory complications. Treatments include fixation, management with opiates, paraspinous local anesthetic pumps, and intercostal nerve blocks. The aim of this study was to evaluate the use of treatment options and compare clinically relevant outcomes. Methods Patients admitted to a Level 1 trauma center with multiple rib fractures between 2015 and 2019 were screened. We included all participants treated with surgical fixation and/or intercostal nerve block or local anesthetic pump. Patients were case-matched 1:2 by Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) Chest and Head, age, and number of rib fractures. Outcomes assessed were hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, pneumonia, and tracheostomy rates. Results We identified 25 patients who received rib fixation and intercostal analgesia. Of these, 14 cases were treated with liposomal bupivaicaine nerve block and 11 by paraspinous catheter block. Fifty control cases treated with opiates were identified. All patients survived to discharge. Cases and controls were approximately equivalent in age, ISS, number of fractured ribs, chest AIS, and head AIS. Rib-plated patients had a lower rate of pneumonia (OR 0.2029, 95% CI 0.0242, 0.09718), decreased average ICU LOS (10.62 vs 6.64, P = .018), and decreased average ventilator days (5.44 vs 1.68, P = .003). Discussion Findings suggest more aggressive treatment of rib fractures may decrease ICU LOS, ventilator days, and pneumonia in patients with multiple rib fractures. These findings are in line with current literature; however, more research is needed in this area.

scholarly journals Thoracic paravertebral block versus intravenous patient-controlled analgesia for pain treatment in patients with multiple rib fractures

2017 ◽  
Vol 45 (6) ◽  
pp. 2085-2091 ◽  
Author(s):  
Ge Yeying ◽  
Yuan Liyong ◽  
Chen Yuebo ◽  
Zhang Yu ◽  
Ye Guangao ◽  
...  
Keyword(s):  
Pain Relief ◽  
Pulmonary Function ◽  
Pain Treatment ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Rib Fractures ◽  
Paravertebral Block ◽  
Patient Controlled Analgesia ◽  
Thoracic Paravertebral Block ◽  
Multiple Rib Fractures

Objectives To assess the effect of thoracic paravertebral block (PVB) on pain management and preservation of pulmonary function compared with intravenous, patient-controlled analgesia (IVPCA) in patients with multiple rib fractures (MRFs). Methods Ninety patients with unilateral MRFs were included in this prospective study and randomly assigned to the TPVB or IVPCA group. The visual analogue scale (VAS) pain score, blood gas analysis, and bedside spirometry were measured and recorded at different time points after analgesia. Results TPVB and IVPCA provided good pain relief. VAS scores were significantly lower in the TPVB group than in the IVPCA group at rest and during coughing ( P < 0.05). Patients in the TPVB group had a higher PaO2 and PaO2/FiO2 and lower P(A–a)O2 compared with the IVPCA group ( P < 0.05). Moreover, patients in the TPVB group showed higher FVC, FEV1/FVC, and PEFR, and fewer complications than did the IVPCA group ( P < 0.05). Conclusion TPVB is superior to IVPCA in pain relief and preservation of pulmonary function in patients with MRFs.

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