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
Randomized Controlled Trial
. 2024 Apr;31(4):316-325.
doi: 10.1111/acem.14820. Epub 2023 Oct 29.

Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial

Swetha Ramesh  1 , S Manu Ayyan  1 , Durga Prasad Rath  2 , Deepthy Melepurakkal Sadanandan  3
Affiliations
Free article
Randomized Controlled Trial

Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial

Swetha Ramesh et al. Acad Emerg Med. 2024 Apr.
Free article

Abstract

Objectives: The primary objective was to compare the analgesic efficacy of ultrasound-guided erector spinae plane block (ESPB) with a sham procedure in adult patients presenting with rib fractures to the emergency department (ED).

Methods: A randomized controlled trial was conducted at an academic ED over a 17-month period. Forty-six adults with confirmed rib fractures and numeric rating score (NRS) greater than 4 were randomized to one of two treatment arms: ultrasound-guided ESPB group or placebo (sham procedure). Intravenous opioids were prescribed as rescue analgesia when self-reported pain scores were ≥4. The primary outcome measure, pain intensity reduction, was derived using the 11-point NRS at six time points over 12 h. Secondary outcome measures included the amount of rescue analgesia, in morphine equivalents, and the occurrence of adverse events. Two-way repeated-measures ANOVA was used to compare the trend in NRSs across the two arms. The association between the complications and intervention was explored using the Fisher's exact test.

Results: Forty-six patients (23 in each arm) completed the study. There was no difference between treatment groups with respect to age, sex, vital signs, preenrollment analgesia, or baseline pain intensity. In comparing pain intensity during the study period, NRS scores at 30, 60, and 120 min were significantly lower in the ESPB group (p < 0.001) during rest and deep inspiration. Moreover, patients in the ESPB group received lesser rescue analgesia than those in the sham group (10 mg, IQR 2.5 vs. 20 mg, IQR 5 mg; p ≤ 0.01). There was no difference in adverse events between groups.

Conclusions: Ultrasound-guided ESPB resulted in significantly reduced pain intensity over the study period and reduced amount of rescue analgesia and had no discernible difference in adverse events when compared with a sham.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Gupta A, Sharma A, Suthar N, Girija H, Verma V, Jindal S. Epidemiological pattern of blunt trauma chest in Western India. Apollo Med. 2020;17(2):66.
    1. Edgecombe L, Sigmon DF, Galuska MA, Angus LD. Thoracic Trauma. StatPearls Publishing; 2022 http://www.ncbi.nlm.nih.gov/books/NBK534843/
    1. Scholten AC, Berben SA, Westmaas AH, et al. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline. Injury. 2015;46(5):798‐806.
    1. Beard L, Holt B, Snelson C, Parcha C, Smith FG, Veenith T. Analgesia of patients with multiple rib fractures in critical care: a survey of healthcare professionals in the UK. Indian J Crit Care Med. 2020;24(3):184‐189.
    1. El Malla DA, Helal RAEF, Zidan TAM, El Mourad MB. The effect of erector spinae block versus serratus plane block on pain scores and diaphragmatic excursion in multiple rib fractures. A prospective randomized trial. Pain Med. 2022;23(3):448‐455.

Publication types

Substances

LinkOut - more resources