The following is a summary of “COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK WITH INTERCOSTAL NERVE BLOCK FOR TRAUMA-ASSOCIATED CHEST WALL PAIN” published in the October 2022 issue of Emergency Medicine by Armin et al.

Pain related to chest wall injuries is a major issue in the emergency department (ED). However, picking the right analgesic method can be difficult. Their objective was to evaluate the efficacy of ultrasound-guided single-shot erector spinae plane block (ESPB) versus intercostal nerve block (ICNB) for pain management following thoracic trauma. A level 1 urban trauma center hosted this randomized, non-blinded clinical experiment. A convenience sample of patients with isolated chest wall damage and initial Numeric Rating Scale pain scores (NRS 0) of more than 5 were included. 

Exclusion criteria included big pain areas, surgical interventions, discharge from the ED, and the presence of contraindications to lidocaine. About 20 minute (NRS 20), 60 minute (NRS 60), and final disposition(disp) pain scores were obtained. About 27 patients in the ESPB and he ICNB groups were enrolled. Mean values of NRS 0, 20, 60, and disp for the ESPB vs. ICNB groups were 8.0 vs. 7.4, 5.2 vs. 6.1, 4.1 vs. 5.4, and 4.3 vs. 5.8, respectively (P=0.07, P=0.04, P=0.001, and P< 0.001, respectively).

About  4 patients in the ESPB and 8 patients in the ICNB groups required the administration of supplementary doses of fentanyl for acceptable pain control (P=0.09). Patients with painful chest wall damage who underwent ultrasound-guided ESPB had better pain control than those who underwent ICNB during their ED stay. We prescribe ESPB in the ED for pain management in blunt or penetrating chest injuries.