Erector Spinae Plane Block for Rib Fracture Analgesia in the Emergency Department
Status:
Not yet recruiting
Trial end date:
2022-08-31
Target enrollment:
Participant gender:
Summary
Rib fractures, while in isolation are self-limited and benign, can be exquisitely painful.
Poorly controlled rib fracture pain can compromise respiratory function leading to increased
morbidity and mortality, especially in the elderly. Currently, opioid medications are the
mainstay of analgesia but are associated with significant adverse effects, such as
respiratory depression and delirium. In an effort to improve acute pain in the ED and
concomitantly reduce opioid use, ultrasound-guided regional anesthesia has been implemented
more frequently The erector spinae plane block (ESPB) is a relatively new ultrasound-guided
procedure for thoracic analgesia.
Previously, the serratus anterior plane (SAP) block has been used for this indication.
However, typical anatomical distribution limits the effectiveness of the SAP block to
anterior rib fractures, while the majority of traumatic rib fractures are posterior, thus
require a more central blockade such as the proposed ESPB. The ESPB can be done as a single
injection into the superficial structures of the back under ultrasound guidance and as such,
is a both a relatively safe and technically easy procedure to perform, especially in
comparison to the more traditional alternatives of epidurals, paravertebral and intercostal
injections.
There have been no prospective studies evaluating the efficacy and safety of the ESPB in the
emergency department setting for acute rib fractures. The investigators hypothesize that the
ESPB will provide improved acute pain scores in the emergency department compared to parental
analgesia alone. Secondarily, investigators hypothesize that this will translate to less
inpatient opioid requirements and improved incentive spirometry values.