Erector spinae plane catheter for pain management of multiple rib fractures: Anecdotal records of cases with blunt chest trauma

Abstract

High-energy chest wall traumas usually lead to multiple rib fractures associated with high morbidity and mortality. Pulmonary morbidity in patients with multiple rib fractures results from the impaired gas exchange from the pulmonary contusion areas and compromised breathing mechanics as a result of severe pain. Thus, analgesia plays a key role in the management of rib fractures. Erector spinae plane (ESP) block is a newly described technique and it has come into use in emergency departments for posterior rib fractures. ESP blocks can be administered in patients under anticoagulant therapy in the intensive care unit because the relevant area is located relatively superficial and far from the major vascular structures. In this report, anecdotal records of three patients with multiple rib fractures who had real benefits from ESP blocks are presented. This report highlights the bilateral extent of the sensory block after unilateral injection, the effect of ESP blocks on weaning from mechanical ventilation, and dramatic improvement in arterial blood gases analysis following ESP catheter insertion.