Hussein Bushra, Mercader Daniel, Theophanous Rebecca G
Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina.
Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina; Durham Veterans Affairs Healthcare System, 508 Fulton St, Durham, North Carolina.
J Emerg Med. 2025 Jan;68:1-14. doi: 10.1016/j.jemermed.2024.07.016. Epub 2024 Aug 14.
Rib fractures are frequently diagnosed and treated in the emergency department (ED). Thoracic trauma has serious morbidity and mortality, particularly in older adults, with complications including pulmonary contusions, hemorrhage, pneumonia, or death. Bedside ED-performed ultrasound-guided anesthesia is gaining in popularity, and early and adequate pain control has shown improved patient outcomes with rare complications.
We describe thoracic nerve block options that can be used clinically for rib fractures or other thoracic pain or trauma. We identify the pros and cons of each type of block, describe their risk profile and advantages, and summarize the steps on how each is performed.
Thoracic epidural and paravertebral blocks are more invasive, targeting the nerves closer to the spinal cord, thus they are primarily used in the operating room or by anesthesiology for surgical cases. However, newer blocks are gaining in popularity, particularly the erector spinae block (ESP), serratus anterior plane nerve block (SANB), and intercostal nerve block (ICNB). These blocks provide adequate anesthesia and can be performed in an ED setting.
Thoracic nerve blocks (e.g., ESP, SANB, ICNB) can be performed safely by appropriately trained emergency physicians, provide excellent anesthesia for rib fractures and thoracic trauma, and should be strongly considered for improved patient-centered outcomes. Furthermore, performing regional nerve blocks in the emergency department can reduce complications including adverse effects from opioids or other delirium-inducing medications.
肋骨骨折常在急诊科进行诊断和治疗。胸部创伤具有严重的发病率和死亡率，尤其是在老年人中，其并发症包括肺挫伤、出血、肺炎或死亡。急诊科床边超声引导下麻醉正日益普及，早期充分的疼痛控制已显示能改善患者预后且并发症罕见。
我们描述可临床用于肋骨骨折或其他胸部疼痛或创伤的胸段神经阻滞方法。我们确定每种阻滞类型的优缺点，描述其风险状况和优势，并总结每种阻滞的操作步骤。
胸段硬膜外阻滞和椎旁阻滞侵入性更强，针对更靠近脊髓的神经，因此主要用于手术室或由麻醉科用于手术病例。然而，新型阻滞方法正日益普及，尤其是竖脊肌阻滞（ESP）、前锯肌平面神经阻滞（SANB）和肋间神经阻滞（ICNB）。这些阻滞能提供充分的麻醉，且可在急诊科进行。
经过适当培训的急诊医生可安全地实施胸段神经阻滞（如ESP、SANB、ICNB），为肋骨骨折和胸部创伤提供出色的麻醉，为改善以患者为中心的预后应予以强烈考虑。此外，在急诊科实施区域神经阻滞可减少并发症，包括阿片类药物或其他导致谵妄的药物的不良反应。
