Ultrasound guided erector spinae plane block versus thoracic epidural analgesia in traumatic flail chest, a prospective randomized trial

Background and Aims: Pain contributes to flail chest morbidities. The aim of this study was to compare the analgesic effects of ultrasound-guided erector spinae plane block (ESPB) with thoracic epidural analgesia (TEA) in patients with traumatic flail chest. Material and Methods: Sixty patients aged 18 - 60 years, ASA I-II, with unilateral flail chest were allocated into TEA group with a loading dose of 6 ml bupivacaine 0.25% and 2 mu g/ml fentanyl and ESPB group with a loading dose of 20 ml bupivacaine 0.25% and 2 mu g/ml fentanyl. This was followed by continuous infusion of 6 ml/hour bupivacaine 0.125% and 2 mu g/ml fentanyl in both groups for 4 days. Pain scores at rest and on coughing, rescue analgesic consumption, PaO2/FIO2 ratio, PaCO2, pulmonary functions and adverse events were recorded. Results: In both groups, Visual Analog Scale (VAS) scores at rest and on coughing were significantly decreased after block initiation as compared to pre-block value. At all-time points, VAS scores at rest and on coughing were insignificantly different between both groups. PaO2/FIO2 ratio, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were significantly increased and respiratory rate, PaCO2, were significantly decreased as compared to pre-block values of the same group without significant difference between both groups. The incidence of hypotension was significantly higher in TEA group than ESPB group. Conclusions: ESPB can achieve adequate analgesia in traumatic flail chest equivalent to that of TEA with significant improvement of arterial oxygenation and pulmonary functions and without serious adverse effects.