(1740) Erector Spinae Plane Block for Regional Pain Management in Rib Fracture: A Network Meta-Analysis

Introduction: Pain control is essential for managing rib fractures to enable deep breathing. Systemic analgesia or regional nerve blocks are commonly used. The Erector Spinae Plane Block (ESPB) is a newer regional nerve block technique, performed under ultrasound guidance. We evaluated its efficacy for pain management in rib fractures.

Methods: On July 21, 2024, we searched the following: PubMed, Embase and Cochrane. Our inclusion criteria were any clinical trial that compared the efficacy of ESPB in managing pain in rib fractures to other types of analgesia. Our outcome was the Visual Analogue Scale (VAS). We used R with netmeta package to perform a network meta-analysis using a random effects model. The network included comparisons among ESPB, sham procedures, IV Morphine, thoracic epidural block, thoracic paravertebral block, and serratus plane block.

Results: Out of the 639 articles we obtained, only 7 papers were included, with a total of 378 patients. VAS scores were evaluated at at 30 minutes, 6 hours, 12 hours, and 24 hours post-intervention. The VAS scores at 30 minutes post-intervention, the ESPB group's VAS score was -0.15 [-0.48; 0.18], similar to sham procedures (0.00 [-0.43; 0.43]), IV Morphine (-0.15 [-0.69; 0.40]), thoracic epidural block (-0.33 [-1.33; 0.67]), thoracic paravertebral block (-0.40 [-0.85; 0.05]), and serratus plane block (-0.40 [-1.02; 0.22]). At 6 hours post-intervention, the ESPB group had a VAS score of -0.33 [-1.33; 0.67], similar to sham procedures (-0.33 [-1.33; 0.67]), IV Morphine (-0.33 [-1.42; 0.76]), thoracic epidural block (-0.18 [-1.24; 0.88]), thoracic paravertebral block (-0.25 [-0.81; 0.30]), and serratus plane block (-0.07 [-1.17; 1.03]). By 12 hours post-intervention, the ESPB group had a VAS score of -0.40 [-0.85; 0.05], comparable to sham procedures and other analgesic measures. At 24 hours post-intervention, the ESPB group's VAS score was -0.75 [-1.91; 0.41], similar to other treatment methods.

Conclusions: The study shows that the Erector Spinae Plane Block (ESPB) could be an effective option for managing pain in patients with rib fractures, providing relief comparable to intravenous opioids, thoracic epidural block, thoracic paravertebral block, and serratus plane block, as indicated by similar VAS scores at multiple time points post-intervention.