Effect of patient position on the spread and sensory block of erector spinae plan block for traumatic chest injury: A prospective randomized study

Background: Erector spinae plane block (ESPB) has documented efficacy in pain management in patients with rib fractures. The clinical outcomes of any myofascial plane block are dependent on the spread of the anesthetic injectate, which could be affected by patient positioning. Although ESPB could be performed in the sitting or lateral positions, no previous studies had compared the analgesic outcomes between these two positions. That was the aim of our trial. Methods: Fifty patients diagnosed with unilateral rib fractures were assigned into two groups according to the position when installing the ESBP; the sitting and lateral decubitus groups (25 patients in each group). The main objectives included sensory block level, pain scores, opioid consumption, and patient satisfaction.Results: Patient criteria, number of fractured ribs, and needling time were comparable between the two groups. However, the lateral decubitus group showed significantly better extents of upper and lower sensory block levels, along with a wider sensory block area. The latter was evident throughout the six hours following the block. Additionally, the lateral decubitus group expressed lower pain scores and less morphine consumption after the procedure. Subsequently, patient satisfaction was significantly better in the lateral decubitus group.Conclusion: The lateral decubitus ESBP is associated with better analgesic outcomes in patients with rib fractures compared to the sitting position.