Safety of Continuous Erector Spinae Catheters in Chest Trauma: A Retrospective Cohort Study.

The erector spinae block is an efficacious analgesic option for the management of rib fracture related pain. Despite there being minimal published data specifically addressing the safety profile of this block, many societies have made statements regarding its safety and its use as an alternative to traditional regional anaesthesia techniques in patients at risk of complications. The primary aim of this study was to characterise the safety profile of erector spinae plane block catheters by determining the incidence of early complications. The secondary aims of this study was to characterise the incidence of late adverse events, as well as, the erector spinae plane block catheter failure rate. We analysed electronic medical record data of patients who had an erector spinae plane block catheter inserted for the management of rib fractures between November 2017 to September 2020. To assess early adverse events data collection included hypotension, hypoxaemia, local anaesthetic systemic toxicity and pneumothorax thought to be associated with erector spinae plane block catheter insertion. Late complications included catheter site infection and catheter site haematoma. Two hundred and twenty four patients received a total of 244 continuous erector spinae catheters during the study period. Following the insertion of the erector spinae there were no immediate complications such as hypotension, hypoxia, local anaesthetic toxicity or pneumothorax. Of all blocks inserted 7.7% were removed due to catheter failure (OR = 8.4 per 100 catheters; 95%CI = 5.1 to 13.9 per 100 catheters). This resulted in a failure rate of 1.9 per 1000 catheter days (95%CI = 1.1 to 6.7 catheter days). Late complications included two erythematous catheter sites and two small haematomas not requiring intervention. The odds of a minor late complication was 16.7 per 1,000 catheters (95%CI = 6.1 to 45.5 per 1,000 catheters). In conclusion, this study supports the statements made by regional anaesthesia societies regarding the safety of the erector spinae plane block. Based on the results presented in this population of trauma patients, the erector spinae plane block catheter is a low risk analgesic technique which may be performed in the presence of abnormal coagulation status or systemic infection.