Related Experiment Video
Updated: May 22, 2026
02:26
Intracranial Pharmacotherapy and Pain Assays in Rodents
Published on: April 9, 2019
Pilot study comparing three analgesia approaches for rib fractures
Eric S Schwenk1, Robert Bloom2, Marc C Torjman3
1Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA Eric.Schwenk@jefferson.edu.
Regional Anesthesia and Pain Medicine
|May 20, 2026
Summary
This pilot study found comparable pain relief and opioid use between erector spinae plane (ESP) block, lidocaine infusion, and multimodal analgesia for elderly rib fracture patients. Pulmonary complications and delirium may be better trial endpoints.
Area of Science:
- Anesthesiology and Pain Management
- Geriatric Trauma Care
- Thoracic Surgery Outcomes
Background:
- Elderly patients with rib fractures face high risks of pulmonary complications and mortality.
- Erector spinae plane (ESP) block and lidocaine infusions are potential analgesic strategies.
- This pilot study aimed to inform a larger clinical trial design.
Purpose of the Study:
- To evaluate the feasibility of a definitive trial comparing ESP block, lidocaine infusion, and multimodal analgesia for rib fractures in the elderly.
- To assess pain, opioid consumption, and pulmonary outcomes in these patient groups.
Main Methods:
- A randomized pilot study involving patients aged 55+ with ≥3 unilateral rib fractures.
- Participants were assigned to ESP catheter, lidocaine infusion, or multimodal analgesia.
- Outcomes included pain ratings, opioid use, vital capacity, delirium, and adverse events over 72 hours.
Main Results:
- No significant differences in pain ratings or opioid consumption were observed between the three groups.
- Three patients receiving lidocaine infusions experienced possible local anesthetic systemic toxicity (LAST).
- Pneumonia occurred more frequently in the control group; delirium was less frequent in the ESP group.
Conclusions:
- Analgesia was similar across all treatment groups in this pilot study.
- Pulmonary complications and delirium may serve as more sensitive endpoints for future trials.
- Careful assessment of LAST is crucial for elderly patients receiving lidocaine infusions.
