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The following is a summary of “Continuous regional anesthesia with erector spinae plane catheters for patients with multiple rib fractures,” published in the March 2025 issue of American Journal of Emergency Medicine by Rauschenbach et al. 

The prevalent use of opioids for acute pain management in patients with rib fracture, despite established risks of addiction and respiratory depression, necessitates the exploration of alternative analgesic modalities, such as the erector spinae plane (ESP) block, which has demonstrated preliminary promise in case series.  

Researchers conducted a retrospective study to evaluate the efficacy and safety of continuous ropivacaine infusion via ESP catheters placed by emergency physicians (EP) for individuals with multiple unilateral rib fractures.  

They identified polytrauma individuals with rib fractures over a 1-year period (2019–2020) who received an ESP catheter placed by EP. The control group included polytrauma individuals without regional anesthesia, matched by age and rib fracture count. The primary outcome was opioid consumption, measured in morphine milligram equivalents per day (MMED), comparing MMED before and after catheter placement in the treatment group and overall (OA) MMED between groups. Secondary outcomes included hospitalization length, intubation rates, and complications. A subgroup analysis was performed on individuals with isolated rib fractures.  

They included 89 individuals in the catheter group, matched with 89 in the control group. Opioid consumption decreased from 89 to 67 MMED after catheter placement (P = 0.003), OA opioid use during hospitalization showed no significant difference between groups (P = 0.57). In individuals with isolated rib fractures, the catheter group showed a trend toward reduced mechanical ventilation days and shorter hospital stays, though statistical significance was not reached.   

Investigators concluded the ESP catheter placement declined opioid use without significant complications and served as a safe, effective adjunct for pain management in rib fractures. 

Source: sciencedirect.com/science/article/abs/pii/S0735675724006971