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Review
Use of fascial plane blocks for traumatic rib fractures: a scoping review
  1. Ahtsham U Niazi1,
  2. Max Solish1,
  3. Aneurin Moorthy2,3,4,
  4. Faizan Niazi1,
  5. Antonio Hermes Abate3,
  6. Catherine Devion5 and
  7. Stephen Choi1
  1. 1Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2Department of Anesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
  3. 3Department of Anesthesia, Cappagh National Orthopaedic Hospital, Dublin, Ireland
  4. 4School of Medicine, University College Dublin, Dublin, Ireland
  5. 5Information Specialist - Sunnybrook Library, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Ahtsham U Niazi; ahtsham.niazi{at}utoronto.ca

Abstract

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

  • REGIONAL ANESTHESIA
  • Acute Pain
  • Pain Management
  • Nerve Block

https://doi.org/10.1136/rapm-2024-106366

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    Footnotes

    • X @AhtshamNiazi, @anomoorthy

    • Contributors All authors contributed to the conception and design of this review. All authors participated in abstract and title screening and data collection. The first draft of the manuscript was written by AUN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. AUN is the guarantor.

    • 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 SC receives in-kind support from CogState (no-cost access to cognitive testing software). The other authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

    • Provenance and peer review Not commissioned; externally peer reviewed.