Intended for healthcare professionals

Search this journal  Enter search terms...   

Access/Pro!le Cart
Advanced search

Browse by discipline  Information for 

The American Surgeon™

Impact Factor: 1.002 / 5-Year Impact Factor: 0.945 JOURNAL HOMEPAGE SUBMIT PAPER

 Restricted access Research article First published online May 5, 2022

Erector Spinae Plane Blocks for Traumatic Rib Fractures: A Prospective, Interventional Study

Benjamin J. Palachick, MD , Ryan A. Carver, MD, […], and Jay N. Collins, MD +2 View all authors and a#liations

Volume 88, Issue 9 https://doi.org/10.1177/00031348221091956

 Contents 

 Get access  Cite article  Share options  Information, rights and permissions  Metrics and citations

Abstract
Background
Rib fractures are present in 10% of all trauma patients and 30% of patients with signi!cant chest trauma.
Pain from rib fractures results in decreased respiratory e"ort which can lead to atelectasis and potentially
pneumonia and death. Pain control is therefore of utmost importance in preventing the complications of rib
fractures by improving respiratory function. Erector spinae plane blocks (ESPB) have been e"ectively used in
elective surgery with subjective and objective improvements in pain.

Materials and Methods

We sought to evaluate subjective pain and objective evaluation of respiratory e"ort by way of incentive
Related content

spirometry levels after administration of an ESPB for patients with rib fractures. Our trauma service applied
ESPB over 2 years in patients with rib fractures. Ultrasound guidance was used to administer 50cc of a long- Similar articles:
acting local anesthetic at the transverse process underneath the erector spinae muscle group. Evaluation of
pain scores and incentive spirometry levels were measured prior to and after the ESPB. Restricted access

Utilization of Percentage of
Results Predicted Forced Vital Capacity to
Stratify Rib Fracture Patients: An
In total, we obtained data from 45 patients. Mean pre-pain scores were 7.93 with post-pain scores of 4.47 (p Updated Clinical Practice Guideline
< 0.001). Mean pre-block incentive spirometry volumes were 1160 cc with post-block IS of 1495cc (p 0.035). Show details 
There were no associated complications.

Restricted access
Discussion
Video-Assisted Thoracoscopic
ESPBs are safe and signi!cantly reduce pain scores and increased incentive spirometry volumes after Internal Rib Fixation
administration. They are easy to perform and can be done by the trauma service, including trainees. ESPB Show details 
has the potential to reduce pulmonary complications of rib fractures, as well as subjectively improving pain
experienced by our trauma patients. Based on our results, we recommend this block as an adjunct to Restricted access
multimodal analgesia for patients with rib fractures. Bedside Incentive Spirometry
Predicts Risk of Pulmonary
Complication in Patients with Rib
Fractures
Get full access to this article
Show details 
View all access and purchase options for this article.

GET ACCESS View more



SAGE recommends:

References SAGE Knowledge

Entry
1. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37:975.
Rib Fracture and Contusions
Crossref | PubMed | Google Scholar
Show details 

2. Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients with rib fractures are at greater risk of death SAGE Knowledge
and pneumonia. J Trauma. 2003;54:478. Entry

Crossref | PubMed | Google Scholar Trunk Injuries

Show details 

3. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48(6):1040-6.
SAGE Knowledge
Crossref | PubMed | Google Scholar Entry

Sternal Fracture

4. Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. Show details 
2003;54(3):615.

Crossref | PubMed | Google Scholar View more

5. Galvagno SM Jr, Smith CE, Varon AJ, et al. Pain management for blunt thoracic trauma: A joint practice
management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology
Society. J Trauma Acute Care Surg. 2016;81(5):936.

Crossref | PubMed | Google Scholar

6. Brasel KJ, Moore EE, Albrecht RA, et al. Western trauma association critical decisions in trauma:
Management of rib fractures. J Trauma Acute Care Surg. 2017;82(1):200.

Crossref | PubMed | Google Scholar

7. Bulger EM, Edwards T, Klotz P, Jurkovich GJ. Epidural analgesia improves outcome after multiple rib
fractures. Surgery. 2004;136(2):426.

Crossref | PubMed | Google Scholar

8. 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;214:117-123.

Crossref | PubMed | Google Scholar

9. Zaw AA, Murry J, Hoang D, et al. Epidural analgesia after rib fractures. Am Surg. 2015;81:950–954.

Crossref | PubMed | Google Scholar

10. Adhikary SD, Pruett A, Forero M, Thiruvenkatarajan V. Erector spinae plane block as an alternative to
epidural analgesia for post‐operative analgesia following video‐assisted thoracoscopic surgery: A case study
and a literature review on the spread of local anaesthetic in the erector spinae plane. Indian J Anaesth.
2018;62:75–8.

Crossref | PubMed | Google Scholar

11. Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block: A novel analgesic technique in
thoracic neuropathic pain regional anesthesia & pain medicine. Reg Anesth Pain Med 2016;41:621-627.

Crossref | PubMed | Google Scholar

12. Schwartzmann A, Peng P, Maciel MA, et al. Mechanism of the erector spinae plane block: Insights from a
magnetic resonance imaging study. Can J Anaesth. 2018;65:1165-6.

Crossref | PubMed | Google Scholar

13. Luftig J, Mantuani D, Herring AA, Dixon B, Clattenburg E. Successful emergency pain control for posterior
rib fractures with ultrasound‐guided erector spinae plane block. Am J Emerg Med. 2018;36(8):1391–1396.

Crossref | PubMed | Google Scholar

14. Carver TW, Milia DJ, Somberg C, Brasel K, Paul J. Vital capacity helps predict pulmonary complications
after rib fractures. J Trauma Acute Care Surg. 2015;79(3):413-6.

Crossref | PubMed | Google Scholar

15. Adhikary SD, Liu WM, Fuller E, Cruz‐Eng H, Chin KJ. The e"ect of erector spinae plane block on respiratory
and analgesic outcomes in multiple rib fractures: A retrospective cohort study. Anaesthesia. 2019; 74(5): 585–
5.

Crossref | PubMed | Google Scholar

You currently have no access to this content. Visit the access options page to authenticate.

View full text | Download PDF

Also from SAGE Publishing

CQ Library Data Planet SAGE Business Cases SAGE Campus

American political resources A universe of data Real-world cases at your !ngertips Online skills and methods courses

SAGE Knowledge SAGE Research Methods SAGE Video Technology from SAGE

The ultimate social science library The ultimate methods library Streaming video collections Make learning and research easier

About Information for The American Surgeon™

About SAGE Journals Authors ISSN: 0003-1348

Accessibility guide Editors Online ISSN: 1555-9823

Historical content Librarians

Permissions Promoters / Advertisers

Terms of use Researchers

Reviewers
SAGE discipline hubs
Societies
SAGE microsites
Frequently asked questions

About SAGE Publishing Contact us CCPA - Do not sell my personal information CCPA Privacy Policy

Copyright © 2023 by Southeastern Surgical Congress

Privacy