Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.09.010
Brazilian Journal of Anesthesiology
Case Report

Continuous erector spinae plane block for analgesia and better pulmonary functions in patients with multiple rib fractures: a prospective descriptive study

Bloqueio contínuo do plano eretor da espinha para analgesia e melhor função pulmonar em pacientes com fraturas múltiplas de costelas: estudo descritivo prospectivo

Rashmi Syal, Sadik Mohammed, Rakesh Kumar, Nidhi Jain, Pradeep Bhatia

Downloads: 0
Views: 688

Abstract

Background 
The present study explored the role of continuous erector spinae plane (ESP) block for analgesia as well as its impact on pulmonary functions in patients with multiple rib fractures.

Methods
Ten patients with multiple rib fractures were enrolled after getting informed and written consent. Ultrasound-guided ESP block was performed at the level midway between the fractured ribs followed by the insertion of the catheter. Pre and post-block VAS score, hemodynamics, respiratory rate (RR), peripheral oxygen saturation (SpO2), inspiratory capacity (IC), blood gases (PaO2 and PCO2), and complications were compared.

Results
Pain scores at rest as well as on movement showed a significant reduction from 5.9 and 7.5 pre block to 1.6 and 2.5 respectively at 96 hours (p < 0.0001). Similarly, RR, SpO2, IC, and PaO2 were significantly better after the block placement (p < 0.001).

Conclusion
Continuous ESP block provide adequate analgesia with better respiratory functions in patients with multiple rib fractures.

Keywords

Rib Fractures;  Erector Spinae Plane Block;  Pulmonary functions;  Analgesia;  Visual Analogous Scale (VAS)

Resumo

Introdução

O presente estudo explorou o papel do bloqueio contínuo do plano eretor da espinha (PEE) para analgesia, bem como seu impacto nas funções pulmonares em pacientes com múltiplas fraturas de costelas.

Métodos

Dez pacientes com fraturas múltiplas de costelas foram incluídos após obtenção de consentimento informado e por escrito. O bloqueio PEE guiado por ultrassom foi realizado no nível médio entre as costelas fraturadas, seguido pela inserção do cateter. Foram comparados escore EVA pré e pós-bloqueio, hemodinâmica, frequência respiratória (FR), saturação periférica de oxigênio (SpO2), capacidade inspiratória (CI), gasometria arterial (PaO2 e PCO2) e complicações.

Resultados

Os escores de dor em repouso e em movimento mostraram uma redução significativa de 5,9 e 7,5 antes do bloqueio para 1,6 e 2,5, respectivamente, às 96 horas (p < 0,0001). Da mesma forma, FR, SpO2, CI e PaO2 foram significativamente melhores após a colocação do bloqueio (p < 0,001).

Conclusão

O bloqueio PEE contínuo proporciona analgesia adequada com melhores funções respiratórias em pacientes com múltiplas fraturas de costelas.

Palavras-chave

Fraturas de Costela; Bloco Plano Eretor da Espinha; Funções pulmonares; Analgesia; Escala Visual Analógica (EVA)

References

1. Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621–7.

2. Adhikary SD, Liu WM, Fuller E, et al. The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia. 2019;74:585–93.

3. Nagaraja PS, Ragavendran S, Singh NG, et al. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth. 2018;21:323–7.

4. Pressley C, Fry W, Philp A, et al. Predicting the outcome of patients with chest wall injury. Am J Surg. 2012;204:910–4.

5. McKendy KM, Lee LF, Boulva K, et al. Epidural analgesia for traumatic rib fractures is associated with worse outcomes: a matched analysis. J Surg Res. 2017;214:117–23.

6. Yang HM, Choi YJ, Kwon HJ, et al. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia. 2018;73:244–50.

7. Batra RK, Krishnan K, Agarwal A. Paravertebbral block. J Anaesthesiol Clin Pharmacol. 2011;27:5–11.

8. Tulgar S, Selvi O, Ozer Z. Clinical experience of ultrasound guided single and bi-level erector spinae plane block for postoperative analgesia in patients undergoing thoracotomy. J Clin Anesth. 2018;50:22–3.

9. Gursoy C, Kuscu Y, Demirbilek SG. Pain Management for Traumatic Rib Fractures with ESP Block in ICU. J Coll Physicians Surg Pak. 2020;30:318–20.

10. Nandhakumar A, Nair A, Bharath VK, et al. Erector spinae plan block may aid weaning from mechanical ventilation in patients with multible rib fractures: Case report of two cases. Indian J Clin Anesth. 2018;62:139–41.


Submitted date:
01/08/2021

Accepted date:
09/05/2021

615ef2dfa953950b835d1823 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections