- Design
- Systematic review and meta-analysis
- Population
- 10 studies of patients after thoracic surgery or chest wall trauma
- Primary outcome
- Pain scores at 1, 24 and 48 hours; opioid consumption
- Effect
- Lower pain at 1 h (p<0.00001), 24 h and 48 h (p=0.0008); opioid use not different
This meta-analysis compared erector spinae plane block with intercostal nerve block for pain after thoracic surgery or chest wall trauma. Ten studies were included after full-text review.
Pain scores were lower with the erector spinae block at 1, 24 and 48 hours. Opioid use at 24 and 48 hours, length of stay and duration of analgesia did not differ significantly. The abstract reports p values rather than the size of the pain difference, so how much lower cannot be judged from it.
For emergency physicians managing rib fractures, the erector spinae block is attractive because it is a single ultrasound-guided injection away from the pleura and neurovascular bundle. The data support it as at least as good as intercostal blocks, but the absence of any opioid-sparing difference tempers the claim of superiority.
- Consider an ultrasound-guided erector spinae plane block for patients with multiple rib fractures and poor pain control.
- Use a block early in older patients with rib fractures, who are at highest risk of pneumonia.
- Continue to measure the effect by pain scores, cough strength and incentive spirometry.
- Check coagulation and anticoagulant use before any regional block.
Why it matters
It supports a block that emergency physicians can learn and perform safely for one of the most common painful injuries in older patients.
Don't overread it
The abstract gives no size for the pain difference, and opioid use did not differ.
The statistics, in plain English
Very small p values say the difference in pain scores was unlikely to be chance, but not how large it was. With no difference in opioid use, the pain gain may be modest in practice.
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