Chest trauma is extremely common, and the incidence is rapidly increasing in the elderly population, with the rapid increase in falls. Rib fractures are always a concern, and the most important factor in their management is pain control.
Over the years, numerous modalities have been described, including:
- Decreasing rib motion using taping or rib belts (highly discouraged due to the incidence of complications)
- Systemic pain medication (may cause respiratory depression)
- Epidural analgesia (contraindicated in patients on anticoagulants)
- Intercostal nerve (rib) blocks (not all ribs accessible)
- Intrapleural analgesia (not very effective, with unpredictable absorption and spread)
- Rib fixation procedures
- Erector spinae plane blocks
In general, we have been moving from more general to very focused pain control. Analgesic usage has predominated, with operative procedures recently becoming more common for select patients.
The new kid on the block now is the erector spinae plane block (ESPB). It is technically easier to provide relief for rib fractures at most levels. It involves small injections and is relatively simple to perform under ultrasound guidance after proper training.
This video is a good introduction to the general concepts and techniques for the ESPB. Obviously, watching a video will not give you the skills to do this yourself. Work with a trained professional to gain experience with this technique.
In my next post, I’ll review the data on the efficacy and value of this block.
