Continuous regional anesthesia with erector spinae plane catheters for patients with multiple rib fractures

Opioids are commonly used for acute pain management in patients with rib fractures, but their use poses known risks of addiction and respiratory depression. Regional anesthesia, namely the erector spinae plane(ESP) block, has shown promise as an alternative to opioids in case series. Our aim was to evaluate the efficacy and safety of continuous ropivacaine infusion ESP catheters performed by emergency physicians(EP) for patients with multiple unilateral rib fractures. This retrospective case control study identified polytrauma patients with rib fractures in a 1-year period between 2019 and 2020 who had an ESP catheter placed by EP. The control group consisted of polytrauma patients who did not receive regional anesthesia and were matched by number of rib fractures and age. Our primary outcome was opioid use in morphine milligram equivalents per day(MMED). We compared MMED before and after catheter placement in the treatment group and overall MMED between the control and catheter group. Secondary outcomes included length of hospitalization, rate of intubation, and complications. Subgroup analysis of the same variables was performed on the group of patients whose only injury was rib fractures. The catheter group included 89 patients, matched with an equal number in the control group. Opioid use decreased from 89 to 67 MMED after catheter placement in the treatment group(P = 0.003). Overall opioid use during hospitalization did not significantly differ between treatment and control groups(P = 0.57). There was a trend toward fewer days of mechanical ventilation and shorter hospital length of stay in the catheter group in patients with isolated rib fractures, but neither of these trends reached statistical significance. Opioid use decreased after ESP catheter implementation and there were no meaningful complications. Although there was no significant difference in opioid use between groups, ESP catheter placement and continuous regional anesthesia by EP is a safe, reasonable adjunct to treat pain from rib fractures.