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Randomized Controlled Trial
. 2022 Jan-Feb;72(1):115-121.
doi: 10.1016/j.bjane.2021.04.004. Epub 2021 Apr 22.

Effects of erector spinae plane block and retrolaminar block on analgesia for multiple rib fractures: a randomized, double-blinded clinical trial

Yaoping Zhao  1 , Yan Tao  1 , Shaoqiang Zheng  1 , Nan Cai  1 , Long Cheng  1 , Hao Xie  2 , Geng Wang  3
Affiliations
Randomized Controlled Trial

Effects of erector spinae plane block and retrolaminar block on analgesia for multiple rib fractures: a randomized, double-blinded clinical trial

Yaoping Zhao et al. Braz J Anesthesiol. 2022 Jan-Feb.

Abstract

Objective: To investigate the effects of Erector Spinae Plane Block (ESPB) and Retrolaminar Block (RLB) on intra- and postoperative analgesia in patients with Multiple Rib Fractures (MRFs).

Methods: A total of 80 MRFs patients were randomly divided into the ESPB (Group E) and RLB (Group R) groups. After general anesthesia, ESPB and RLB were performed under ultrasound guidance, respectively, together with 20 mL of 0.5% ropivacaine and Patient-Controlled Intravenous Analgesia (PCIA).

Results: Thirty-four cases in Group E and 33,cases in Group R showed unclear paravertebral spaces. The intraoperative dosage of remifentanil (mean ± SD) (392.8 ± 118.7 vs. 501.7 ± 190.0 μg) and postoperative morphine PCIA dosage, (7.35 ± 1.55 vs. 14.73 ± 2.18 mg) in Group R were significantly less than those in Group E; the Visual Analog Scale (VAS) scores in Group R at 2 (2.7 ± 1.2 vs. 3.4 ± 1.4), 4 (2.2 ± 1.1 vs. 2.8 ± 0.9), 12 (2.5 ± 0.9 vs. 3.0 ± 0.8), and 24 hours (2.6 ± 1.0 vs. 3.1 ± 0.9) after surgery were significantly lower than those in Group E. Finally, the normal respiratory diaphragm activity (2.17 ± 0.22 vs. 2.05 ± 0.19), pH (median [IQR] (7.38 [7.31-7.45] vs. 7.36 [7.30-7.42]), and partial pressure of carbon dioxide (PaCO2) (44 [35-49] vs. 42.5 [30-46]) after the operation in Group R were significantly better than those in Group E (p < 0.05).

Conclusions: RLB was a more effective analgesic method than ESPB in the treatment of MRF.

Keywords: Analgesia; Clinical trial; Nerve block; Rib fractures; Ultrasound imaging.

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Figures

Figure 1
Figure 1
Ultrasound images of erector spinae plane block and retrolaminar block: (A) Erector spinae plane block; (B) Retrolaminar block. Trapezius Muscle (TM), Rhomboid Major Muscle (RMM), Erector Spinae Muscle (ESM), Transverse Process (TP), Pleural Effusion (PE), Transversospinalis Muscle (Transversospinalis).
Figure 2
Figure 2
CONSORT Flow diagram.
Figure 3
Figure 3
Scanning of paravertebral space in MRF patients: (A) sagittal scanning of paravertebral space. (B) Transverse scanning of paravertebral space. Trapezius Muscle (TM), Rhomboid Major Muscle (RMM), Erector Spinae Muscle (ESM), Transverse Process (TP), Pleural Effusion (PE).
Figure 4
Figure 4
Comparison of VAS scores between groups.
See this image and copyright information in PMC

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