Effectiveness of erector spinae plane block for traumatic rib fracture analgesia
Date
2024
Authors
Harford, Philip James
Editors
Advisors
Munn, Zachary
Pollock, Danielle
Pollock, Danielle
Journal Title
Journal ISSN
Volume Title
Type:
Thesis
Citation
Statement of Responsibility
Conference Name
Abstract
Traumatic rib fractures remain one of the most common injuries sustained by adult patients presenting to hospital following a trauma. Rib fractures have significant implications for the trauma patient, representing significant morbidity through associated complications in the respiratory system. Effective analgesia can help to ensure patients can successfully deep breathe, cough and mobilise, and reduce the burden and associated potential complications. The erector spinae plane block is an emerging regional anaesthetic technique which purports to offer analgesia for multi-level rib fractures with minimal adverse events, however its use in practice is currently based mainly on observational data. This review within this thesis aimed to collate and meta-analyse the contemporary field of experimental trials investigating the erector spinae plane block against other interventions (neuraxial, regional, parenteral) to examine if it offers superior analgesia. Answering this question will help clinicians faced with options to provide analgesia to rib fracture patients – is the erector spinae plane block a superior regional anaesthetic technique for rib fracture patients? We searched databases across several platforms for both published trials and registries for ongoing randomised or quasi-randomised trials comparing the erector spinae plane block against any other intervention specific to traumatic rib fracture analgesia. Records returned were then screened by two independent reviewers at both the title/abstract and full-text level, followed by assessment of risk of bias using the Cochrane Risk of Bias 2.0 tool. Included data was inputted into an extraction tool designed specifically for this review and synthesised using both narrative review and meta-analysis, where appropriate. Seven trials with 432 patients were identified for analysis, involving five comparator interventions. The erector spinae plane block showed no significant additional benefit over comparators in both narrative analysis and limited pooled meta-analysis. Analysis of adjuvant analgesia use showed that the erector spinae plane block offered no benefit in pooled limited meta-analysis. Respiratory outcomes were heterogeneously reported, however no significant difference was found. Using erector spinae plane block as an analgesic technique for patients with traumatic rib fractures is a viable option and offers similar analgesic effects to all studied interventions in this review, without additional benefit. This is an important finding, given its widespread use and potential advantage to other regional techniques for the thorax and its safety profile, however this needs to be explored further. The erector spinae plane block needs to undergo further investigations (including randomised controlled trials and using catheter-based techniques) to determine its place in the landscape of analgesic management of traumatic rib fracture pain.
School/Discipline
School of Public Health : JBI
Dissertation Note
Thesis (MPhil.) -- University of Adelaide, School of Public Health : JBI, 2025
Provenance
This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals