Zigray Haley C, Shiue Lacey T, Barzee Brigham M, Hyde Robert J, Stephens Daniel, Kummer Tobias
Department of Emergency Medicine, Mayo Clinic Health System - Northwest Wisconsin region, Eau Claire, WI, USA.
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
Injury. 2025 Sep;56(9):112569. doi: 10.1016/j.injury.2025.112569. Epub 2025 Jul 1.
Rib fractures are associated with substantial morbidity and mortality. Ultrasound-guided erector spinae plane block (ESPB) is increasingly used to manage pain in patients with rib fractures. However, ESPBs are often performed by proceduralists with extensive experience in regional anesthesia. The purpose of this study was to determine whether nonspecialized physicians could effectively perform ESPBs in patients with rib fracture pain in the emergency department.
In a prospective convenience sample of 19 patients who came to the emergency department with rib fractures, ESPBs were performed by resident physicians under the supervision of experienced attending physicians. Pain scores, opioid use in morphine milligram equivalents (MME) per day, forced vital capacity, and maximum inspiratory pressure (MIP) were compared before and at several time points after ESPB.
Pain scores were higher before ESPB (median [IQR], 7.0 [6.0-8.0]) than at any time point after the procedure (P = .018). Median (IQR) opioid usage before ESPB was 57.6 (43.5-92.6) MME/d, which was significantly reduced at 24 h after ESPB (median [IQR], 51.5 [29.5-82.9] MME/d; P = .020) and during the remainder of the patients' stay (median [IQR], 33.8 [9.6-50.7] MME/d; P = .003). Further analyses showed that MIP before ESPB (median [IQR], 27.5 [6.3-32.5] cm HO) was significantly lower than that at 0 to 6 h (median [IQR], 40.0 [35.0-60.0] cm HO; P = .040), 12 to 18 h (median [IQR], 49.0 [30.0-60.0] cm HO; P = .039), and 18 to 24 h (median [IQR], 60.0 [35.0-60.0] cm HO; P = .028) after ESPB. No complications, 30-day readmissions, adverse events, or deaths occurred.
When adequately educated and supervised by experienced physicians, nonspecialized proceduralists can safely perform the ESPB procedure in the emergency department to provide effective analgesia to patients with rib fractures. ESPBs significantly decreased pain scores, reduced opioid usage, and improved respiratory mechanics.
肋骨骨折与较高的发病率和死亡率相关。超声引导下竖脊肌平面阻滞（ESPB）越来越多地用于管理肋骨骨折患者的疼痛。然而，ESPB通常由在区域麻醉方面有丰富经验的操作人员进行。本研究的目的是确定非专科医生能否在急诊科对肋骨骨折疼痛患者有效地实施ESPB。
在一个前瞻性便利样本中，19例因肋骨骨折前来急诊科就诊的患者，由住院医师在经验丰富的主治医师监督下进行ESPB。比较ESPB前及术后几个时间点的疼痛评分、以吗啡毫克当量（MME）计算的每日阿片类药物使用量、用力肺活量和最大吸气压力（MIP）。
ESPB前的疼痛评分（中位数[四分位间距]，7.0[6.0 - 8.0]）高于术后任何时间点（P = 0.018）。ESPB前阿片类药物使用量的中位数（四分位间距）为57.6（43.5 - 92.6）MME/d，在ESPB后24小时（中位数[四分位间距]，51.5[29.5 - 82.9]MME/d；P = 0.020）及患者住院剩余时间（中位数[四分位间距]，33.8[9.6 - 50.7]MME/d；P = 0.003）显著降低。进一步分析显示，ESPB前的MIP（中位数[四分位间距]，27.5[6.3 - 32.5]cm H₂O）显著低于ESPB后0至6小时（中位数[四分位间距]，40.0[35.0 - 60.0]cm H₂O；P = 0.040）、12至18小时（中位数[四分位间距]，49.0[30.0 - 60.0]cm H₂O；P = 0.039）和18至24小时（中位数[四分位间距]，60.0[35.0 - 60.0]cm H₂O；P = 0.028）。未发生并发症、30天再入院、不良事件或死亡。
在经验丰富的医生进行充分培训和监督下，非专科操作人员可在急诊科安全地实施ESPB操作，为肋骨骨折患者提供有效的镇痛。ESPB显著降低了疼痛评分，减少了阿片类药物使用量，并改善了呼吸力学。
