THORACIC ERECTOR SPINAE PLANE BLOCK VERSUS PARAVERTEBRAL BLOCK UNDER ULTRASOUND GUIDANCE IN PAIN MANAGEMENT OF PATIENTS WITH MULTIPLE RIB FRACTURES. A RANDOMIZED CONTROL TRIAL.

Background: Pain associated with traumatic multiple fracture ribs is usually severe, difficult to control, frequently alters pulmonary mechanics, and may even limit movement ability. Thoracic epidural and paravertebral blocks (PVB) have traditionally been employed but they are technically complex, are associated with adverse effects and are often not feasible in the presence of conditions such as coagulopathy, hemo-dynamic instability and vertebral fractures. ESPB is a simple block in terms of easy identification of landmarks with ultrasound and safe block with no neurovascular structures in the ESP. Hence the current study was undertaken to assess clinical utility of this block (ESPB) in comparison with paravertebral blocks (PVB) for pain relief in multiple rib fractures. Methodology: A prospective, randomized, double-blinded study was conducted in 100 adult patients with traumatic multiple rib fractures, during April 2020 to February 2023 after obtaining institutional ethical committee approval. ESPB and PBV was performed under ultrasound guidance. Haemodynamic changes, opioid consumption, time to recue analgesia and VAS scores in both the groups were recorded. Statistical analysis done using independent sample T test when data was normally distributed and Mann whitney U test for skewed distribution with outliers with P<0.05 as statistically significant. SPSS version 20 was the statistical software used. Results: Mean of HR and MAP showed no significant difference in both the groups. Mean and SD of fentanyl consumption in patients of group PVB (176.87± 27.5 microgram) was more which was statistically significant when compared to group ESPB (134.9± 35.8 microgram). VAS static and dynamic showed no significant difference in both the groups when measured periodically in the first 48 hours. Conclusions: In conclusion, ESPB and PVB blocks in multiple rib fractures are effective methods for pain relief with similar haemodynamic effects. ESPB has the advantage of significant decrease in fentanyl consumption and increased time to rescue analgesia compared to PVB. [ABSTRACT FROM AUTHOR]