Erector Spinae Plane Block as an Analgesic Intervention in Acute Rib Fractures: A Scoping Review

Abstract

Introduction

Rib fractures are a common sequelae of chest trauma and are associated with significant morbidity. The erector spinae nerve block (ESB) has been proposed as an alternative first-line regional technique for rib fractures due to ease of administration and minimal complication profile. We aimed to investigate the current literature surrounding this topic with a focus on pain and respiratory outcomes.

Methods

A comprehensive literature search was performed on the Medline, Embase, Web of Science, Scopus, and Cochrane databases. Keywords of “erector spinae block” and “rib fractures” were used to form the search strategy. Papers published in English investigating ESB as an analgesic intervention for acute rib fracture were included. Exclusion criteria were operative rib fixation, or where the indication for ESB was not rib fracture.

Results

There were 37 studies which met the inclusion criteria for this scoping review. Of these, 31 studies reported on pain outcomes and demonstrated a 40% decrease in pain scores post administration within the first 24 hours. Respiratory parameters were reported in 8 studies where an increase in incentive spirometry was demonstrated. Respiratory complication was not consistently reported. ESB was associated with minimal complications; only 5 cases of haematoma and infection were (incidence 0.6%) reported, none of which required further intervention.

Discussion

Current literature surrounding ESB in rib fracture management provides a positive qualitative evaluation of efficacy and safety. Improvements in pain and respiratory parameters were almost universal. The notable outcome from this review was the improved safety profile of ESB. The ESB was not associated with complications requiring intervention even in the setting of anticoagulation and coagulopathy. There still remains a paucity of large cohort, prospective data. Moreover, no current studies reflect an improvement in respiratory complication rates compared to current techniques. Taken together, these areas should be the focus of any future research.

Keywords:

• chest trauma
• thoracic injury
• regional anaesthesia
• nerve block

Abbreviations

ESB, erector spinae block; PRISMA, Preferred reporting items for systematic reviews and meta analyses; JBI, Joanna Briggs Institute; LOS, length of stay; ICU, intensive care unit; RCT, randomised control trial; SD, standard deviation; NRS, numerical rating scale; VAS, visual analogue scale; DVP, Defence and Veterans pain; FVC, forced vital capacity; SAB, serratus anterior block; TPVB, thoracic paravertebral block.

Acknowledgments

The authors would like to thank the Department of Anaesthesia, Austin Health for their support of this paper. The authors would also like to acknowledge the efforts of the Austin Health Library team for their assistance with the search strategy.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

No funding was received for this study.