Chris Anstey

Background Numerous regional techniques are available to provide analgesia and reduce complications related to rib fractures. There is a paucity of evidence comparing the efficacy of these techniques. This pilot study aims to assess the efficacy of erector spinae plane block (ESPB) versus paravertebral block (PVB) catheters for rib fracture analgesia. Methods Patients who received either an ESPB or PVB catheter for rib fracture analgesia over the study period (April 2017 to September 2020) were eligible for inclusion. Patients were matched based on demographics and injury characteristics. Outcomes of interest included pre and post catheter-insertion numerical pain scores at rest and with movement, and time to rescue analgesia following catheter insertion. Results Thirty-four matched patients were included in this study. Pain scores at rest and with movement were significantly reduced in both groups. There were no statistically significant differences in post-block pain scores or time to rescue analgesia between the two groups. Fifteen (88.2%) of those in both groups had a documented subjective improvement in pain, inspiratory effort or cough strength. Conclusion This pilot study is the first to show that the recently described ESPB technique provides non-inferior analgesia compared to PVB for the management of rib fractures. Both techniques were effective in reducing pain scores and had similar times to rescue analgesia. This study supports claim that the ESPB is an effective alternative to traditional regional techniques in the management of rib fractures.