Who Hits the Target? Erector Spinae Plane Block versus Epidural Analgesia in Traumatic Rib Fractures

Introduction: There is limited evidence comparing the comparative outcomes of the erector spinae plane (ESP) block versus thoracic epidural analgesia (EA). This study aims to compare analgesia-related outcomes between ESP block and EA including self-reported pain and opioid analgesic requirements. Methods: This is a 5-y (2018-2022) retrospective analysis at an American College of Surgeons level I trauma center. Trauma patients aged ≥18 y with isolated rib fractures who received either ESP block or EA were included and compared. Primary outcomes were incentive spirometry (IS) volume change (post-pre), daily pain scores, and opioid analgesics received within the 4 d following the procedure. Secondary outcomes were major complications and hospital and intensive care unit length of stay. Multivariable linear regression analyses were performed to estimate adjusted associations. Results: A total of 102 patients were identified, of which 50 received ESP block. The mean age was 62 y and 63% were male. Both groups had comparable injury severity and IS volume (ESP: 750 versus EA: 809; P = 0.650) before receiving analgesia. There was no significant difference in overall major complications (8.0% versus 9.6%, P = 0.774). On multivariable analyses, ESP catheters were associated with a greater increase in IS volume (β = +0.359, 95% confidence interval (CI) [+0.058 to +0.660], P = 0.024), lower pain scores (β = −1.598, 95% CI [−2.739 to −0.458], P = 0.007), and lower daily opioid requirements (β = −1.126, 95% CI [−2.210 to −0.410], P = 0.042). Conclusions: Despite no differences in major complications and length of stay, ESP use was associated with lower pain and opioid requirements and greater IS volume increases than EA. Prospective studies should further investigate this potential association and assess the use of these modalities in care pathways.