- http://orcid.org/0000-0001-8917-0556Edmund Chan,
- Ganeshkrishna Nair,
- Amit Pawa
- Department of Anaesthesia, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
- Correspondence to Dr Amit Pawa, Department of Anaesthesia, Guy's and Saint Thomas' NHS Foundation Trust, London SE1 9RT, UK;
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To the Editor,
Since its original description in 2016,1 the ultrasound-guided erector spinae plane (ESP) block, a regional anaesthesia technique, has become increasingly popular and the potential clinical applications have been increasing.2 A popular indication is analgesia for rib fracture management. Although randomised controlled trial (RCT) -level evidence for the ESP block is lacking in rib fractures, a recent retrospective cohort study3 has shown increased incentive spirometry values and reduced pain scores in the first 24 hours after implementation of the ESP block compared with before block administration. Alternative techniques, such as thoracic epidurals and paravertebral blockade, have greater potential for complications and steeper learning curves. The serratus anterior plane block’s efficacy has been questioned in patients with posterior rib fractures, with potential technical challenges if surgical emphysema or chest drains are present.3 This makes the ESP block an attractive proposition in management of these challenging patients.
At our institution, a survey of senior anaesthetic trainees highlighted the need for training in ESP blockade as a tool in their armamentarium for rib fracture analgesia when a thoracic epidural was not feasible or practical. …
Contributors EC created the porcine model, drafted the manuscript and undertook the teaching session. GN designed and undertook the teaching session in which the described model was used. AP is the senior author. He edited the manuscript and taught at the teaching session.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests AP has received honoraria from GE healthcare for teaching and consults for B Braun Medical. This work did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Provenance and peer review Not commissioned; internally peer reviewed.
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