Erector spinae plane block may aid weaning from mechanical ventilation in patients with multiple rib fractures: Case report of two cases

Amar Nandhakumar, Amritha Nair, V Kiran Bharath, Sriraam Kalingarayar, Balaji P Ramaswamy, D Dhatchinamoorthi, Amar Nandhakumar, Amritha Nair, V Kiran Bharath, Sriraam Kalingarayar, Balaji P Ramaswamy, D Dhatchinamoorthi

Abstract

Uncontrolled pain in patients with rib fracture leads to atelectasis and impaired cough which can progress to pneumonia and respiratory failure necessitating mechanical ventilation. Of the various pain modalities, regional anaesthesia (epidural and paravertebral) is better than systemic and oral analgesics. The erector spinae plane block (ESPB) is a new modality in the armamentarium for the management of pain in multiple rib fractures, which is simple to perform and without major complications. We report a case series where ESPB helped in weaning the patients from mechanical ventilation. Further randomised controlled studies are warranted in comparing their efficacy in relation to other regional anaesthetic techniques.

Keywords: Analgesia; erector spinae plane block; rib fracture; ventilation.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Three-dimensional reconstructed image of rib fractures
Figure 2
Figure 2
Ultrasound image of the erector spinae plane block (a) Level of T4. Arrow indicates T4 transverse process. TPZ – Trapezius muscle; RM – Rhomboid major; ES – Erector spinae; LA – Local anaesthetic, Cath – Catheter. (b) Level of T8. Arrow indicates T8 transverse process. ES – Erector spinae; LA – Local anaesthetic. LA is in the shape of Kayak

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Source: PubMed

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