Oyetunji Okunola, RN, DNP, CRNA

DNP Nurse Anesthesia

Integrative Review on the Analgesic Effect of Erector Spinae Plane Block on Adult Patients with Rib Fractures: DNP Project Manuscript

Project Category: Evidence Synthesis 

Project Team: Oyetunji Okunola, DNP, CRNA, Stanislas Chi, DNP, CRNA, Stephen A. Flaherty, CRNA, PhD & Franklin McShane, DNP, APRN, CRNA (Advisors)

Abstract

Background: Erector spinae plane block (ESPB) is an ultrasound-guided fascial plane block that provides excellent analgesia to patients with rib fractures with fewer complications. Despite its clinical benefits and low-risk profile, healthcare providers have been reluctant to adopt this technique. This review examined the analgesic effects of ESPB in comparison to thoracic epidural analgesia (TEA), paravertebral block (PVB), systemic opioid, retrolaminar block (RLB), and serratus anterior plane block (SAPB).

Methods: A comprehensive search was conducted from CINAHL, Embase and PubMed. Two reviewers independently evaluated each study using the JBI critical appraisal checklist and extracted data for synthesis. Primary outcomes measured were pain scores and respiratory function. Adverse events, total analgesic consumption, and hospital length of stay were secondary outcomes measured.

Results: Twenty-one articles met the inclusion criteria with a total sample size of 1366 subjects. Seven randomized control trials (RCT), one non-randomized quasi-experimental, and thirteen cohort studies were examined. Fifteen studies measured pain scores between groups. Eleven studies compared respiratory function between ESPB and other groups to evaluate pulmonary improvement post-intervention. The data synthesis revealed that ESPB administered within 12 hours of hospital admission for rib fracture was associated with improved respiratory function, reduction in pain scores and opioid consumption, and hemodynamic stability for up to 96 hours following rib fracture compared to systemic opioid and SAPB.

Conclusion:  This synthesis project revealed that although TEA, the current preferred analgesic treatment, provides lower pain scores compared to ESPB, it has a higher incidence of bradycardia and hypotension.