Thoracic Epidural as a Rescue Analgesic in a Patient with a Continuous Erector Spinae Plane Block for Rib Fractures: A Case Report
BACKGROUND Rib fractures are a common traumatic injury with significant morbidity and mortality resulting from respiratory compromise. Regional anesthetic techniques have demonstrated efficacy in reducing morbidity and mortality from rib fractures, but there is limited evidence comparing various tec...
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Published in | The American journal of case reports Vol. 24; p. e938875 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
United States
International Scientific Literature, Inc
18.04.2023
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Subjects | |
Online Access | Get full text |
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Summary: | BACKGROUND Rib fractures are a common traumatic injury with significant morbidity and mortality resulting from respiratory compromise. Regional anesthetic techniques have demonstrated efficacy in reducing morbidity and mortality from rib fractures, but there is limited evidence comparing various techniques, and in complex trauma patients various factors may preclude the use of neuraxial and other techniques. CASE REPORT We report the case of a 72-year-old man who presented with left 4th-11th rib fractures. He was initially managed with a continuous erector spinae plane catheter, which resulted in improved pain and incentive spirometry. Unfortunately, he continued to decline and ultimately was rescued from impending respiratory failure by placement of a T6-T7 epidural catheter and epidural infusion of bupivacaine. CONCLUSIONS This case report suggests that a continuous erector spinae plane block may be a useful regional anesthesia technique in the management of rib fractures through its potential to improve pain control and increase incentive spirometry volumes. It also suggests that there may be limitations to its utility given the continued decline of the patient, who was eventually rescued from respiratory failure by placement of a thoracic epidural. Unique to erector spinae plane blocks are the ability to be managed in the outpatient setting, improved safety profile, ease of placement, and potential to be placed in patients with coagulopathy and on anticoagulation therapies. |
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Bibliography: | ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 Funds Collection Authors’ Contribution Conflict of interest: Ian J. Coblentz, MD: No potential conflict of interest relevant to this article was reported • Brian M. Ilfeld, MD, MS: Dr. Ilfeld’s institution has received funding and/or product for his research from Epimed International, InfuTronix, Avanos Medical, and SPR Therapeutics • John J. Finneran IV, MD: Dr. Finneran’s institution has received funding and/or product for his research from Epimed International, InfuTronix, Avanos Medical, and SPR Therapeutics Data Interpretation Financial support: None declared Literature Search Data Collection Study Design Manuscript Preparation Statistical Analysis |
ISSN: | 1941-5923 1941-5923 |
DOI: | 10.12659/AJCR.938875 |