A. S. Patel1, J. Ritter1, R. Kempski1, J. McDonald1, C. Reid1, D. Golden1, B. R. Porter1, R. Behm1 1Guthrie Robert Packer Hospital, General Surgery, Sayre, PA, USA
Introduction:
Managing pain associated with rib fractures is essential for optimal patient care in the trauma setting. Erector spinae plane (ESP) block, a novel ultrasound-guided anesthetic delivery technique, has shown effective rib fracture pain management. Despite existing literature, ESP use in rural trauma centers remains understudied. This study aims to assess the effects of ESP block vs multimodal pain regime (MMPR) on patients with multiple rib fractures at a rural tertiary teaching hospital.
Methods:
In this retrospective case-control study covering January 2017 to September 2021, trauma patients with multiple rib fractures were analyzed. Collected data encompassed patient demographics, hospital, and intensive care unit (ICU) length of stay (LOS), rib fracture count, BMI, comorbidities, incentive spirometry, ESP block administration, readmission, and discharge status. Statistical analysis employed two-sample t-tests, Chi square tests, univariate analysis, and one-way ANOVAs. In this abstract we are unable to present the results of our entire cohort as we are in the process of data collection for year 2015, 2016, 2022 and 2023 and performing a propensity score analysis to match patients 1:1 based on age, sex, BMI, Hypertension, Diabetes, Injury severity score (ISS) and Incentive Spirometry (IS).
Results:
A total of 483 patients were included, of whom 6% (n=29) received ESP blocks, with the remaining 94% (n=454) not receiving the intervention. No substantial disparities were observed in COPD, renal failure, CHF, or PVD rates between the groups. Notably, ESP block recipients exhibited significantly higher BMI (32.7, SD=6.6 vs 29.2, SD=7.06, p=0.012) and diabetes prevalence (p=0.041). Other demographic factors, such as age, sex, fracture laterality, smoking status, and medical practice assignment, demonstrated no significant differences. The ESP group indicated higher utilization of incentive spirometry (p=.048) and more frequent occurrences of lower spirometry values (21.4% <500mL vs 9.1% <500mL; 57.1% 500-1000mL vs 26.5% 500-1000mL, p<.001). While intubation rates remained similar, ESP block recipients were more likely to require re-intubation (10.3%, n=3 vs 1.5%, n=7, p=0.001). No significant variance emerged in chest tube insertion or oral anticoagulant/antiplatelet use. Patients receiving ESP blocks experienced longer average hospital LOS (7.97 days, SD=4.98 vs 3.49 days, SD=7.06, p<0.001) and ICU LOS (4.06 days, SD=6.1 vs 1.97 days, SD=2.82, p=0.006). Moreover, ESP block recipients had a higher likelihood of direct ICU admission (p=<0.001). Discharge type, disposition, and readmission did not significantly differ.
Conclusion:
Patient undergoing ESP block has higher hospital and ICU LOS than patients undergoing MMPR. Patient with higher ISS and Lower IS at the time of admission are two most important factor prolonging the total hospital LOS.