The erector spinae plane block provides analgesia for rib fractures. It is similar to 3 in 1 blocks that we are comfortable performing for femoral neck fractures. It requires ultrasound guidance and high volume (30-40ml) of dilute anesthetic to allow the medication to spread below a fascial plane.
For a decent video demonstrating the block, check out: https://www.youtube.com/watch?v=O9RB0K7f8pM
Interestingly, the block was only just described in the anesthesia literature in 2016 but it has already become quite the rage.
Why? It is simple, effective and the incidence of complications is felt to be low.
However, it looks like it hasn’t really made its way into the Emergency Department.
Enter two Canadian emergency doctors who published a case series of 9 patients. Ok… a pilot study and not great science.
The mean reduction in NRS pain scores went from about 10 to 3.5. So, it seemed to work pretty darn well. Of course, they cannot make any claims about safety, but other literature has somewhat addressed this.
The authors appropriate state that more research is needed but they “feel that the erector spinae plane block should be considered in patients with acute rib fracture pain as a method of pain control in multi-modal analgesia.”
I think this is probably a fair conclusion. We perform a multitude of blocks in the ED. With appropriate training, this can probably be added to our armamentarium.
Surdhar I, Jelic T. The erector spinae plane block for acute pain management in emergency department patients with rib fractures. Can J Emerg Med. 2022;24:50-54. [link to article]