Comparing the analgesic utility & safety of erector spinae plane block versus thoracic epidural for multiple rib fracture trauma: a retrospective cohort analysis.

PURPOSE: Despite long-standing use of thoracic epidural block (TEB) for multiple rib fracture trauma, emerging research suggests that the erector spinae plane block (ESPB) offers similar analgesia and increased safety benefits. This study compared the analgesic effectiveness and safety of TEB versus ESPB for multiple rib fracture trauma.

METHODS

A historical cohort analysis was conducted, including 324 adult patients who received continuous TEB (n = 188) or ESPB (n = 136) plus multimodal analgesia following multiple rib fracture trauma. The primary objective compared average numeric pain scale (NPS) scores at rest and with activity over the first five days of local anesthetic infusion. Other outcomes included opioid consumption, length of stay data, venous thromboembolism (VTE) prophylaxis time measures, as well as vasoactive support, complication, and mortality rates.

RESULTS

Average pre- and post-block NPS scores at rest were greater in the TEB group [5.6 (2.1) vs. 4.8 (2.2), p = 0.002; 48-72 h: 3.7 (2.2) vs. 2.9 (2.2), p = 0.002, respectively). However, the daily changes in NPS scores throughout anesthetic infusion were similar between groups, without significant difference in opioid consumption. First VTE prophylaxis was given prior to block placement more frequently in the ESPB group (66.9 vs. 31.4%, p < 0.001), and median time between pre and post block VTE prophylactic doses was shorter [12.6 (13.7) vs. 23.9 (12.3) hours, p < 0.001].

CONCLUSION

Continuous TEB and ESPB demonstrated similar analgesic efficacy for multiple rib fracture trauma. The ESPB group received earlier VTE prophylaxis without disruption in dose administration for block placement, supporting enhanced safety of ESPB.