Impact of Ultrasound-Guided Continuous Retro Laminar Block versus Continuous Erector Spinae Plane Block on Incentive Spirometry Volumes and Pain Scores in Multiple Rib Fractures: A Prospective Randomized Clinical Double-Blinded Trial

Abstract Background: Retrolaminar block (RLB) is an innovative thoracic truncal block for managing somatic pain in the abdominal and thoracic walls. Erector spinae plane block (ESPB) has been effectively used to relieve acute neuropathic rib pain. This work aimed to assess the incentive spirometry volume and analgesic effectiveness of ultrasound (US)-guided continuous RLB and continuous ESPB among individuals with numerous rib fractures. Materials and Methods: This prospective, randomized, double-blinded, parallel-group, superiority clinical trial was conducted on 60 individuals with unilateral multiple traumatic rib fractures (≥3 ribs). Participants were divided equally into two groups (all received a bolus dose of 20 mL 0.25% bupivacaine, followed by continuous infusion at a 0.1 mL/kg/h rate for 4 days): Group I received US-guided RLB, and Group II received US-guided ESPB. Results: Visual Analog Scale scores at rest and during coughing were significantly lower at all measured intervals (30 min, 60 min, 6 h, 12 h, 18 h, and 24 h) in Group II versus Group I ( P < 0.05). Inspiratory capacity was significantly higher in Group II at the same time points ( P < 0.05). Morphine consumption was significantly lower in Group II at 24 h ( P = 0.001). No significant differences were noted between groups in total morphine use, intensive care unit/hospital stay length, hypotension, bradycardia, hematoma, or catheter retention. No cases of pneumothorax, local anesthetic toxicity, respiratory depression, insertion site infection, or abscess occurred in either group. Conclusions: In patients with multiple rib fractures, ESPB demonstrated superior inspiratory capacity, pain relief, and reduced morphine consumption compared to RLB.