Erector spinae plane catheters: a potentially safer alternative in anticoagulated rib fracture patients

An 86-year-old woman presented to the emergency department following a ground-level fall with fractures of the left posterior ribs 9-11 and right posterior ribs 5-8. She was admitted, and multimodal pain management, including acetaminophen, methocarbamol, oxycodone, and hydromorphone, was initiated. On the second day of hospitalization, she developed somnolence and confusion attributed to opioid administration. She was unable to receive a thoracic epidural due to recent clopidogrel administration, and bilateral erector spinae plane catheters were shown to be a reasonable alternative. This intervention provided effective pain relief, leading to improved mental status, pain control, and incentive spirometry.