Analgesic efficacy of ultrasound-guided erector spinae plane block versus costotransverse foramen block in patients with chest trauma: A randomized controlled study.

Abstract

Thoracic epidural anesthesia and paravertebral blocks (PVBs) are the gold standard techniques for pain relief of chest trauma, but they are technically challenging and have failure rates. The Erector Spinae Plane block (ESPB) is a PVB surrogate that provides effective hemi-thoracic analgesia. The costotransverse foramen block (CTFB) is a novel block that deposits local anaesthetic adjacent to the costotransverse foramen. We hypothesized that CFTB might offer superior analgesia compared to ESPB. This double-blinded, prospective, randomized controlled trial was conducted in the emergency department (ED) of a tertiary care institution. Fifty-eight patients with chest trauma were randomized into two groups, Group-1 (USG-ESPB; n = 29) or Group-2 (USG-CTFB; n = 29). The primary outcome was to compare pain scores in the Numeric Rating Scale (NRS) at 20 min. The secondary outcomes were onset and duration of analgesia, pain score at fixed time intervals, block failure rates, need for rescue analgesia, assessment of pain score at one and three months, and adverse events. Demographic and vital parameters were similar between the two groups. Baseline pain scores recorded at rest [9.6(0.8) vs 9.5(0.9)] and on movement [9.8(0.6) vs 9.8(0.6)] did not differ. At 20 min following intervention, mean pain scores at rest were very similar in both groups [5.2 (1.7) vs. 5.3 (1.5)] (mean difference: 0.1; 95% CI: -0.55 to 0.50; P = 0.94). Pain scores during movement were also very similar in both groups [6.4 (1.7) vs. 6.3 (1.4)] (mean difference: 0.1; 95% CI: -0.43 to 0.62; P = 0.76). The NRS score was persistently lower in the CTFB group at all other designated time points, though the difference was not statistically significant. The onset, duration, requirement of rescue analgesia, and block failure were similar. There were no complications in any group. During assessments at one and three months, both techniques yielded equivalent pain control. CTFB provides analgesia equivalent to ESPB in terms of acute and long-term pain relief, onset, duration, and opioid consumption for chest trauma patients. CTFB, however, is technically more challenging, and ESPB is a safer and more user-friendly option.