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.