Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Thoracic Paravertebral Block for Pain Relief in Patients with Multiple Fractured Ribs

Background: Patients with rib fractures or chest contusions are unable to cough or breathe deeply, which may lead to atelectasis and pneumonia. And the cornerstone of management of rib fractures is aggressive treatment of this pain. Ultrasound guided (US) regional techniques was linked with fewer adverse effects and higher efficacy if compared with systemic therapy with multiple rib fractures. We designed this work for comparing the efficacy and safety of thoracic paravertebral block (TPVB) versus erector spinae plane block (ESPB) in cases with multiple fractured ribs.

Methods: This is a double-blinded prospective randomized controlled trial which was conducted on 60 patients aged ≥ 18 years of both sexes. The participants had unilateral multiple fractured ribs (≥ 3 ribs), and they were randomly enrolled into two equal groups. Group I had US guided TPVB. Bupivacaine 0.25% in a volume of 20 mL was injected in a bolus dose, then a continuous infusion of bupivacaine 0.25% at a rate of 0.1 mL/kg/hr. Group II received (US) guided ESPB. Bupivacaine 0.25% in a volume of 20 mL was injected in a bolus dose and then suspected to a continuous infusion of bupivacaine 0.25% at a rate of 0.1 mL/kg/hr.

Results: Visual analogue score (VAS) decreased significantly after institution of blocks (p-value <0.05) without considerable difference between two groups (P >0.05). And total morphine consumption was insignificant between two groups (P =0.836). Also, heart rate (HR) and mean arterial blood pressure (MAP) decreased significantly compared to pre-block values in both groups with an insignificant difference between the two groups (P >0.05). Moreover, respiratory, and arterial blood gases (ABG) parameters improved significantly in both groups in the form of reduced in respiratory rate (RR), elevated oxygen saturation, and increase in P/F ratio with an insignificant difference between the two groups (P >0.05). Occurrence of complications as hypotension, bradycardia and pneumothorax was less in ESPB group than TPVB group.

Conclusions: ESPB is nearly effective as TPVB to relief pain in cases with rib fractures as demonstrated by significant decrease in VAS scores in both groups.