Highlights
- •Severe rib fractures require multi-modal pain regimens which can include neuraxial blockades.
- •Chemoprophylaxis has to be held when performing these blockades, placing patients at increase risk for venothrombotic events.
- •The erector spinae plane block is a new blockade that can be safely placed while not holding chemoprophylaxis.
Abstract
Background
Current guidelines for severe rib fractures recommend neuraxial blockade in addition
to multimodal pain therapies. While the guidelines for venous thromboembolism prevention
recommend chemoprophylaxis, these medications must be held for neuraxial blockade
placement. Erector spinae plane block (ESPB) is a newly described block for thoracic
pain control. Advantages include its quick learning curve and potential for less bleeding
complications. We describe the use of ESPB for rib fractures in patients on chemoprophylaxis.
We hypothesize that ESPB can be performed in this patient population without holding
chemoprophylaxis.
Materials and methods
This was a retrospective observational cohort study of a level 1 trauma center from
9/2016 to 12/2018. All patients with trauma with rib fractures undergoing neuraxial
blockade or ESPB were included. Demographics, chemoprophylaxis and anticoagulation
regimens, outcomes, and complications were collected.
Results
Nine hundred sixty-four patients with rib fracture(s) were admitted. Of these, 73
had a pain management consult. Thirteen had epidural catheters and 25 had ESPBs placed.
There was no difference in demographics, injury patterns, bleeding complications,
or venous thromboembolism rates among the groups. Patients with ESPB were less likely
to have a dose of chemoprophylaxis held because of placement of a catheter (25% versus 100%, P < 0.00001). Three patients with ESPB were on oral anticoagulation on admission, and
two were able to continue their regimen during placement.
Conclusions
ESPB can be safely placed in patients on chemoprophylaxis. It should be considered
over traditional blocks in patients with blunt chest wall trauma because of its technical
ease and ability to be performed with chemoprophylaxis.
Keywords
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Article info
Publication history
Published online: February 27, 2021
Accepted:
January 22,
2021
Received in revised form:
January 19,
2021
Received:
January 23,
2020
Identification
Copyright
Published by Elsevier Inc.
