Retrospective review of rib fracture management at a trauma centre
Research type
Research Study
Full title
A retrospective review of rib fracture pain management at a London Major Trauma Centre comparing Erector Spinae Plane Blocks, Serratus Anterior Plane Blocks and Epidurals
IRAS ID
276933
Contact name
Boyne Bellew
Contact email
Sponsor organisation
Imperial College London and Imperial College Healthcare NHS Trust
Duration of Study in the UK
0 years, 4 months, 0 days
Research summary
Rib fractures are commonly seen in Trauma Centres around the world and are associated with multiple short term and long term complications, including pneumonia, respiratory failure and chronic pain. These typically arise due to poor pain relief in the acute setting and the provision of adequate analgesia is therefore a key priority in managing these patients.
Epidurals and paravertebral blocks are the most widely advocated treatment option, and until recently, if these have been contraindicated options are limited. In these circumstances, morphine based products are used, which have many disadvantages, in particular cough suppression and respiratory depression.
Advances in ultrasound use in anaesthesia has led to the development of novel fascial plane regional anaesthetic 'nerve blocks', which can provide good pain relief to patients with rib fractures. The commonly used blocks are called Serratus Anterior Plane Blocks (SAPB) and Erector Spinae Plane Blocks (ESPB). The evidence base for these techniques, particularly in rib injuries, is limited to case reports and small case series. Trials are not currently forthcoming. Womack et al recently published a large retrospective cohort study examining the safety and efficacy of ultrasound guided paravertebral block analgesia for the management of rib fracture pain in comparison to SAPB, ESPB and epidurals. Listed as the largest cohort study of its kind to date, there were unclear definitions of "effective" analgesia with no use of quantitative pain scoring systems for successful analgesia.
Our institution has incorporated SAPBs and ESPBs into our armamentarium for patients as an alternative to epidural analgesia with anecdotal success and we are currently undertaking a randomised controlled trial for the SAPB. We want to review the success and complications associated with these techniques in this group of patients to improve the quality of information available to clinicians managing patients with rib injuries.
REC name
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REC reference
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