Utility of Ultrasound Guided Erector Spinae Plane Block in Patients Presenting to the Emergency Department with Rib Fractures

Context: Alleviating significant pain and enhancing lung function in patients with multiple rib fractures presents a formidable challenge to all Emergency Physicians (EP). 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 Emergency Physicians alike. Here in this study, we aim to ascertain the utility of a regional myofascial block technique that can be applied in patients suffering from multiple rib fractures in the ED.

AIMS:

1.       To determine the effectiveness of an Ultrasound (USG) guided Erector Spinae Plane Block (ESPB) in ameliorating pain and improving lung function in patients presenting to the ED with multiple rib fractures.

2.       To assess the safety and the feasibility of the ESPB in the ED.

Setting and Design: A retrospective observational clinical study will be conducted in the ED of a tertiary care hospital over a period of 12 months.

Methods and Material: Data regarding all patients with rib fractures who had undergone an Erector Spinae Plane Block in the ED will be extracted from the Emergency Department Procedure Register and the In-Patient Case Sheets will be obtained from the Medical Records Department for review and analysis. The data shall include, but will not be limited to, the Numeric Rating Scale of pain and respiratory parameters i.e. Respiratory Rate and PEFR at 30 minutes post procedure and subsequently after every top-up dose, up to a period of 48 hours.

Statistical Analysis: Descriptive statistics like Mean, Standard deviation, Frequency and Percentage shall be used. Inferential statistics like Repeated Measure Anova shall be done using SPSS software version 22, (IBM).

Results: The mean NRS was significantly reduced by >50% at 30 minutes and by 72% over a 48 hour 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 minutes 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 Emergency Department. No adverse events as a consequence of the ESPB were noted.

Key words: Rib Fractures, Erector Spinae Plane Block, Ultrasound, Emergency Department, NRS, Respiratory Parameters.