Anterior cutaneous nerve block for analgesia in anterior chest trauma: is the parasternal approach necessary?

Use of fascial plane blocks for traumatic rib fractures: a scoping review

BACKGROUND

The primary cause of morbidity and mortality in traumatic rib fractures is respiratory complications due to compromised respiratory mechanics secondary to pain and opioid-related respiratory depression. Thoracic epidural analgesia (TEA) provides effective analgesia but may not be possible in patients due to spinal cord injuries, thoracic vertebral fractures, and coagulopathy. New thoracic fascial plane blocks provide new options for patients with multiple rib fractures (MRFs).

OBJECTIVE

Our primary objective was to assess the effectiveness of thoracic fascial plane blocks for patients with MRFs by looking at pain control, opioid consumption, and respiratory function postblock compared with preblock.

EVIDENCE REVIEW

Literature was searched using keywords and controlled terms, based on the two concepts "rib fractures" and "fascial plane blocks". Terms were searched in PubMed, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Web of Science, Scopus, Google Scholar and ClinicalTrials.gov from inception to October 11, 2023, using medical subject headings (MeSH) and free-text terms without date or language restrictions. The terms included rib fractures, thoracic trauma, chest injuries, fascial plane blocks, PEC 1, PEC 2, PEC 3, pectoralis plane, serratus anterior plane (SAPB) and erector spinae plane block.

FINDINGS

The available evidence shows that erector spinae plane block and SAPB are effective blocks to provide analgesia and reduce opioid requirements in patients with unilateral or bilateral rib fractures.

CONCLUSIONS

More randomized control studies are needed to compare these blocks with paravertebral block or TEA to see if they provide analgesia, improve respiratory function, and reduce opioid requirements.

Interventional Pain Procedures: A Narrative Review Focusing on Safety and Complications. Part 1 Injections for Spinal Pain

In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic- or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.