Written by Megan Hilbert
Spoon Feed
For patients with traumatic rib fractures, the erector spinae plane block (ESPB) is a reasonable procedure to add to your multimodal pain management and can be completed by resident physicians safely with appropriate supervision.
I can breathe easy now, the pain is gone
There is significant mortality associated with rib fractures, particularly in patients ≥ 65 years. As with other fractures, efforts have been made to prove the efficacy and safety of regional anesthesia to reduce systemic opioid administration.
This was a prospective observational study completed on a convenience sample of 19 adult patients with traumatic rib fractures. Primary outcomes included patient-reported pain scores, total dosage of opioids in morphine milligram equivalents (MME), pulmonary function––forced vital capacity (FVC) and maximum inspiratory pressure (MIP)––all of which were evaluated before and at various time points after completion of ESPB. Secondary outcomes included pulmonary complications, adverse events, 30-day readmission, hospital length of stay, death, ICU admission, and technical success rate of procedure.
Result: The ESPB showed improvement in all outcomes (except FVC). There was a 100% technical success rate and no significant adverse events.
Limitations include the small sample size, although the authors appropriately acknowledge this and suggest this is more of a feasibility study, demonstrating that this block can be completed by “non-experienced” operators with the appropriate experienced supervisor.
Image inserted from the paper itself––look at that beautiful hydro-dissection! My little ultrasound heart is sad that I can’t walk you through completion of the ESPB itself, but if you are not familiar with it you should definitely talk to your ultrasound folks and learn it.
How will this change my practice?
Being that I am ultrasound fellowship trained, I am already on the search for regional anesthesia opportunities for the residents that I work with. This is a plane block that I will continue to keep in my back pocket for my patients with traumatic rib fractures.
Source
Ultrasound-guided erector spinae plane block for traumatic rib fractures: A feasible method of analgesia for the nonspecialized emergency physician. Injury. 2025 Sep;56(9):112569. doi: 10.1016/j.injury.2025.112569. Epub 2025 Jul 1. PMID: 40628600.
