Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

Effects of erector spinae plane block and retrolaminar block on analgesia for multiple rib fractures: a randomized, double-blinded clinical trial

Yaoping Zhao, Yan Tao, Shaoqiang Zheng, Nan Cai, Long Cheng, Hao Xie, Geng Wang

Downloads: 0
Views: 8


To investigate the effects of Erector Spinae Plane Block (ESPB) and Retrolaminar Block (RLB) on intra- and postoperative analgesia in patients with Multiple Rib Fractures (MRFs).

A total of 80 MRFs patients were randomly divided into the ESPB (Group E) and RLB (Group R) groups. After general anesthesia, ESPB and RLB were performed under ultrasound guidance, respectively, together with 20 mL of 0.5% ropivacaine and Patient-Controlled Intravenous Analgesia (PCIA).

Thirty-four cases in Group E and 33,cases in Group R showed unclear paravertebral spaces. The intraoperative dosage of remifentanil (mean ± SD) (392.8 ± 118.7 vs. 501.7 ± 190.0 μg) and postoperative morphine PCIA dosage, (7.35 ± 1.55 vs. 14.73 ± 2.18 mg) in Group R were significantly less than those in Group E; the Visual Analog Scale (VAS) scores in Group R at 2 (2.7 ± 1.2 vs. 3.4 ± 1.4), 4 (2.2 ± 1.1 vs. 2.8 ± 0.9), 12 (2.5 ± 0.9 vs. 3.0 ± 0.8), and 24 hours (2.6 ± 1.0 vs. 3.1 ± 0.9) after surgery were significantly lower than those in Group E. Finally, the normal respiratory diaphragm activity (2.17 ± 0.22 vs. 2.05 ± 0.19), pH (median [IQR] (7.38 [7.31–7.45] vs. 7.36 [7.30–7.42]), and partial pressure of carbon dioxide (PaCO2) (44 [35–49] vs. 42.5 [30–46]) after the operation in Group R were significantly better than those in Group E (p < 0.05).

RLB was a more effective analgesic method than ESPB in the treatment of MRF.


Clinical trial,  Rib fractures,  Nerve block,  Ultrasound imaging,  Analgesia


1 O.P. Sharma, M.F. Oswanski, S. Jolly, et al. Perils of rib fractures Am Surg., 74 (2008), pp. 310-314

2 J.C. Ballantyne, D.B. Carr, S. deFerranti, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials Anesth Analg., 86 (1998), pp. 598-612

3 M.K. Karmakar Thoracic paravertebral block Anesthesiology., 95 (2001), pp. 771-780

4 S. Tulgar, O. Selvi, O. Senturk, et al. Ultrasound-guided erector spinae plane block/indications, complications, and effects on acute and chronic pain based on a single-center experience Cureus., 11 (2019), Article e3815

5 J.L. Zeballos, C. Voscopoulos, M. Kapottos, et al. Ultrasound-guided retrolaminar paravertebral block Anaesthsia., 68 (2013), pp. 649-651

6 M. Damjanovska, T. Stopar Pintaric, E. Cvetko, et al. The ultrasound-guided retrolaminar block: volume-dependent injectate distribution J Pain Res., 11 (2017), pp. 293-299

7 F. Muñoz, J. Cubillos, A.J. Bonilla, et al. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery Can J Anaesth., 64 (2017), pp. 880-882

8 P. Scimia, E. Basso Ricci, A. Droghetti, et al. The ultrasound-guided continuous erector spinae plane block for postoperative analgesia in video-assisted thoracoscopic lobectomy Reg Anesth Pain Med., 42 (2017), p. 537

9 D. Nagane, H. Ueshima, H. Otake Upper lobectomy of the left lung using a left retrolaminar block J Clin Anesth., 49 (2018), p. 74

10 M. Forero, S.D. Adhikary, H. Lopez, et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain Reg Anesth Pain Med., 41 (2016), pp. 621-627

11 H.M. McCormack, D.J. Horne, S. Sheather Clinical applications of visual analogue scales: a critical review Psychol Med., 18 (1988), pp. 1007-1019

12 J. Ayoub, R. Cohendy, M. Dauzat, et al. Non-invasive quantification of diaphragm kinetics using m-mode sonography Can J Anaesth., 44 (1997), pp. 739-744

13 Y. Liu, S. Xu, Q. Yu, et al. Surgical versus conservative therapy for multiple rib fractures: a retrospective analysis Ann Transl Med., 6 (2018), p. 439

14 J. Richardson, S. Sabanathan, R. Shah Post-thoracotomy spirometric lung function: the effect of analgesia. A review J Cardiovasc Surg (Torino)., 40 (1999), pp. 445-456

15 A.M. Ho, M.K. Karmaker, L.A. Critchley Acute pain management of patients with multiple fractured ribs: a focus on regional techniques Curt Opin Crit Care., 17 (2011), pp. 323-327

16 T.M. Cook, R.H. Riley Analgesia following thoracotomy: a survey of Australian practice Anaesth Intensive Care., 25 (1997), pp. 520-524

17 M. Mohta, P. Verma, A.K. Saxena, et al. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs – a pilot study J Trauma., 66 (2009), pp. 1096-1101

18 D.L. Hamilton, B. Manickam Erector spinae plane block for pain relief in rib fractures Br J Anaesth., 118 (2017), pp. 474-475

19 C. Voscopoulos, D. Palaniappan, J. Zeballos, et al. The ultrasound-guided retrolaminar block Can J Anaeshth., 60 (2013), pp. 888-895

20 K.J. Chin, L. Malhas, A. Perlas The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery Reg Anesth Pain Med., 42 (2017), pp. 372-376

21 H.M. Yang, Y.J. Choi, H.J. Kwon, et al. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study Anaesthesia., 73 (2018), pp. 1244-1250

22 T. Murouchi, M. Yamakage Retrolaminar block: analgesic efficacy and safety evaluation J Anesth., 30 (2016), pp. 1003-1007

23 F.R. Rocha, A.K. Brüggemann, D.S. Francisco, et al. Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD J Bras Pneumol., 43 (2017), pp. 32-37

24 X. Pi, Y. Cui, C. Wang, et al. Low tidal volume with PEEP and recruitment expedite the recovery of pulmonary function Int J Clin Exp Pathol., 8 (2015), pp. 14305-14314

25 S. Biswas, R. Verma, V.K. Bhatia, et al. Comparison between Thoracic Epidural Block and Thoracic Paravertebral Block for Post Thoracotomy Pain Relief J Clin Diagn Res., 10 (2016), pp. 8-12

60982e5aa953956b962138b3 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections