Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb;62(2):139-141.
doi: 10.4103/ija.IJA_599_17.

Erector spinae plane block may aid weaning from mechanical ventilation in patients with multiple rib fractures: Case report of two cases

Amar Nandhakumar  1 , Amritha Nair  1 , V Kiran Bharath  1 , Sriraam Kalingarayar  1 , Balaji P Ramaswamy  1 , D Dhatchinamoorthi  1
Affiliations

Erector spinae plane block may aid weaning from mechanical ventilation in patients with multiple rib fractures: Case report of two cases

Amar Nandhakumar et al. Indian J Anaesth. 2018 Feb.

Abstract

Uncontrolled pain in patients with rib fracture leads to atelectasis and impaired cough which can progress to pneumonia and respiratory failure necessitating mechanical ventilation. Of the various pain modalities, regional anaesthesia (epidural and paravertebral) is better than systemic and oral analgesics. The erector spinae plane block (ESPB) is a new modality in the armamentarium for the management of pain in multiple rib fractures, which is simple to perform and without major complications. We report a case series where ESPB helped in weaning the patients from mechanical ventilation. Further randomised controlled studies are warranted in comparing their efficacy in relation to other regional anaesthetic techniques.

Keywords: Analgesia; erector spinae plane block; rib fracture; ventilation.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Three-dimensional reconstructed image of rib fractures
Figure 2
Figure 2
Ultrasound image of the erector spinae plane block (a) Level of T4. Arrow indicates T4 transverse process. TPZ – Trapezius muscle; RM – Rhomboid major; ES – Erector spinae; LA – Local anaesthetic, Cath – Catheter. (b) Level of T8. Arrow indicates T8 transverse process. ES – Erector spinae; LA – Local anaesthetic. LA is in the shape of Kayak
See this image and copyright information in PMC

References

    1. Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37:975–9. - PubMed
    1. Ho AM, Karmakar MK, Critchley LA. Acute pain management of patients with multiple fractured ribs: A focus on regional techniques. Curr Opin Crit Care. 2011;17:323–7. - PubMed
    1. Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. Br J Anaesth. 2017;118:474–5. - PubMed
    1. Carrier FM, Turgeon AF, Nicole PC, Trépanier CA, Fergusson DA, Thauvette D, et al. Effect of epidural analgesia in patients with traumatic rib fractures: A systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2009;56:230–42. - PubMed
    1. Chin KJ, Adhikary S, Forero M. Is the erector spinae plane (ESP) block a sheath block? A reply. Anaesthesia. 2017;72:916–7. - PubMed