Conference Coverage

Erector Spinae Plane Block Outperforms Thoracic Epidural for Rib Fracture Pain Relief

Kate Young

Key Highlights

  • Erector spinae plane block (ESPB) resulted in significantly lower pain scores at rest and with activity compared to thoracic epidural block (TEB).
  • Time to first venous thromboembolism (VTE) prophylaxis was shorter in ESPB patients.
  • TEB patients had shorter ventilation times in the ICU.
  • All block techniques—TEB, ESPB, and SAPB—provided effective analgesia with minimal complications.

In a retrospective cohort study evaluating pain control methods for rib fracture trauma, the erector spinae plane block (ESPB) demonstrated superior analgesic outcomes compared with thoracic epidural block (TEB), notably with reduced pain both at rest and during activity. Despite minimal differences in complications, ESPB was associated with faster VTE prophylaxis initiation and comparable outcomes in opioid use and hospital length of stay, supporting its use as a viable and potentially safer alternative to TEB. Researchers from the Hartford Hospital in Hartford, CR presented their results at the 50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in Orlando, FL.

Traumatic rib fractures pose a significant risk of pain-related respiratory complications. Thoracic epidural block has traditionally been used for pain control, but its limitations—including technical challenges and contraindications—have prompted interest in regional alternatives such as ESPB and serratus anterior plane block (SAPB). This study sought to evaluate whether these newer techniques could provide analgesia equivalent to or better than TEB.

The study retrospectively reviewed 336 patients with rib fractures treated at a single site between 2017 and 2021. Patients received either TEB (n = 188), ESPB (n = 136), or SAPB (n = 12). The primary outcomes assessed were average pain scores (at rest and with activity), opioid consumption (measured in morphine-milligram equivalents), and hospital, ICU, and emergency department length of stay. Secondary outcomes included time to ambulation, VTE prophylaxis initiation, need for mechanical ventilation, and complication rates.

Patients receiving ESPB reported significantly lower pain scores at rest (P = .002) and with activity (P = .029) compared to those who received TEB. The ESPB group also had a shorter median time to VTE prophylaxis (P = .002), potentially due to fewer restrictions on anticoagulation use. However, TEB patients experienced significantly shorter ventilation times in the ICU (P = .04). While ESPB patients had a slightly longer ED stay (P = .038), total hospital and ICU length of stay did not differ significantly across groups. There were no statistically significant differences in mortality or serious complications between groups.

“All pain management interventions provided effective analgesia for patients with traumatic rib fractures with minimal complications observed,” the study authors concluded. “ESPB achieved better analgesia compared to TEB in this study.”​

Reference:
Merchant N, Vincze S, Chhabra J, et al. Continuous regional nerve blocks vs. thoracic epidural block for rib fracture trauma: a retrospective cohort study. Poster presented at: American Society of Regional Anesthesia and Pain Medicine; May 1; Orlando, FL.