Comparison of thoracic epidural and thoracic erector spinae plane block for pain relief of posterolateral rib fractures-a retrospective cohort study

Background Pain from rib fractures (posterior/lateral/anterior) is associated with significant pulmonary morbidity. Earlier epidural and paravertebral blocks were implemented in the algorithm for multimodal pain management of rib fracture pain. Administration of these blocks are fraught with challenges encountered in intensive care unit (ICU). The erector spinae plane block (ESPB) is a viable alternative in ICU set up. This retrospective study compared continuous thoracic ESPB and continuous thoracic epidural analgesia (TEA) [n=28 versus n=24] for polytrauma patients who sustained unilateral multiple rib fractures (MRFs), i.e., more than 3 admitted in ICU. Demography data were noted and compared. Outcome measures were block efficacy in terms of pain scores, opioid consumption (intravenous fentanyl), technical difficulties, and complications. Results Age, gender, and sides of ribs fractures were comparable in all groups. Pain scores and fentanyl consumption were significantly better in patients who received TEA. Conclusions Though statistically significant analgesic efficacy was observed with continuous TEA for managing pain due to unilateral posterolateral MRFs, the small sample size was a major limitation. Further prospective comparative study including effects on incentive spirometry and effectiveness of chest physiotherapy is warranted. However, continuous ESPB is simple and safe to perform with few theoretical contraindications.