Ultrasound-Guided Truncal Blocks for Tube Thoracostomy Analgesia in the Emergency Department

Tube thoracostomy is a common yet exceedingly painful emergency department (ED) procedure requiring potent analgesia for safe performance. Traditionally, emergency physicians provide premedication or procedural sedation in combination with local anesthetic infiltration of the insertion tract prior to tube thoracostomy. However, more advanced pain management strategies, such as ultrasound-guided truncal blocks, may offer a targeted and effective analgesic alternative.

Herein, the authors discuss the thoracic paravertebral, erector spinae, and serratus plane blocks, and their potential application in the ED to provide more comprehensive pain control of tube thoracostomy.

Truncal blocks are local anesthetic injections that target hemithoracic nerves within a compartment or fascial plane, producing ipsilateral chest wall analgesia or anesthesia across multiple contiguous thoracic dermatomes. These ultrasound-guided regional anesthesia techniques may obviate the need for sedation or high-dose opioid therapy, reshaping traditional pain management paradigms for ED tube thoracostomy.

Ultrasound-guided regional anesthesia is increasingly employed in the emergency care setting as part of an opioid-sparing, multimodal pain management strategy. For chest tube insertion, truncal blocks can provide safe yet potent anesthetic coverage spanning up to the full thickness of the thoracic wall, limiting the need for other adjunctive therapies to facilitate procedural performance.