Erector spinae plane block versus thoracic epidural block as analgesic techniques for chest trauma

Abstract

Background Effective analgesia, early mobilization, and respiratory support are the main goals for managing patients with rib fractures. The purpose of this study was to compare the differences between either continuous thoracic epidural and erector spinae plane (ESP) block in patients with chest trauma. Patients and methods This prospective study included 50 patients with American Society of Anesthesiologists status I and II, aged between 18 and 65 years old, admitted with chest trauma. The patients were randomly allocated into two equal groups: ESP block group and thoracic epidural analgesia group. A bolus dose of 15 ml of 0.125% bupivacaine was received in both groups and then continuous infusion was done by using 0.25% bupivacaine at the rate of 0.1 ml/kg/h for 48 h. The primary outcome was to evaluate analgesic efficacy all over the 48 h. Secondary outcomes were the total analgesic requirements during the 48 h, the time of first analgesic request, the effect on hemodynamic parameters, in addition to assessment of the amelioration in respiratory functions and inflammatory substance level between the two groups. Results Both groups had statistically significant decrease in the visual analog scale score after intervention compared with their pre-interventional values (P<0.01), without statistically significant difference between them (P≥0.05). Moreover, hemodynamic parameter, pulmonary functions, and inflammatory substance levels showed statistical improvement (P<0.01), but it was not statistically different between both groups (P≥0.05), except only mean arterial pressure values showed statistical significance between the two groups(P<0.01). Conclusions ESP block is comparable to thoracic epidural in providing analgesia for patients with thoracic trauma.