Analgesic effect of rhomboid intercostal block with sub serratus plane block versus thoracic erector Spinae block in multiple rib fractures: A randomized study

Background: Managing pain in patients with rib fractures poses significant challenges, the medical community has developed ultrasound (US)-guided myofascial plane blocks. These blocks have shown to be a useful method of delivering analgesia while minimizing the occurrence of unwanted effects. The objective of this research is to compare and evaluate the analgesic efficacy of US-guided rhomboid intercostal block in combination with sub-serratus plane block (RISS) with that of US-guided thoracic erector spinae block (ESPB) in patients with numerous rib fractures.Methods:A comparative prospective randomized double-blind study involving 90 patients who had sustained unilateral multiple fractures (≥ three ribs) was conducted.Patients were categorized equally into 2 groups. Group I: received ESPB in the form of a bolus dose of 30 mL of bupivacaine 0.25% and group II: received RISS block using a mixture of 30 ml of bupivacaine 0.25%. Results: Total morphine consumption during the first 24 hours was significantly high in ESPB group. The time to first analgesic requirement was significantly short in ESPB group.Peak expiratory flow rate in ESPB group and RISS group showed significant elevation at 30 min and 6 hrs., 12 hr. and 24 hr. post block as compared to admission, while it showed significant elevation at 12 hrs in RISS group as compared to ESPB group. Numerical pain rating scale was significantly higher in ESPB group at 12 hours. Conclusions: RISS block is more effective for pain relief at 12 hours, for increasing time to first analgesic requirement and for decreasing total morphine consumption than ESPB.