American Society of Regional Anesthesia and Pain Medicine February 2018 - 20
with the programmed intermittent bolus regimen. Using a catheter
fixation device and meticulous dressing at the time of placement
has reduced catheter dislodgement rates (Figures 6A and B).
patients who we judge are able to safely manage an ambulatory
infusion of local anesthetic.
The APMS team communicates daily with the trauma surgery team
regarding progress and discharge planning. The ESP catheter is
kept in place as long as it is providing analgesic benefit. Factors
such as respiratory status, ambulation, oral intake of medications,
and chest tube removal are taken into account when deciding when
to remove the ESP catheter. The catheter may also be removed if
the site becomes infected, local anesthetic leaks, or at the patient's
request. Currently, patients are not routinely discharged with ESP
catheters in situ, although we have occasionally done so in selected
1.
Karmakar MK, Ho AM-H. Acute pain management of patients with multiple
fractured ribs. J Trauma. 2003;54:615-625.
2.
Malekpour M, Hashmi A, Dove J, et al. Analgesic choice in management
of rib fractures: paravertebral block or epidural analgesia? Anesth Analg.
2017;124(6):1906-1911.
3.
Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block: a novel
analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med.
2016;41(5):621-627.
4.
Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib
fractures. Br J Anaesth. 2017;118(3):474-475.
20
REFERENCES
American Society of Regional Anesthesia and Pain Medicine
2018
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