Position of catheter-through-needle erector spinae plane catheters for rib fracture analgesia assessed by computed...

Erector spinae plane catheters are increasingly used for rib fracture analgesia, but the influence of catheter insertion technique on catheter position and analgesic effectiveness remains uncertain. In this case series, we describe 11 erector spinae plane catheters inserted using a catheter-through-needle technique for analgesia in patients with rib fractures who underwent chest computed tomography after catheter insertion. Catheter tip position outside the intended fascial plane was identified in six of 11 (55%) catheters. Previous studies of catheter-over-needle systems have reported displacement rates of up to 89%, but cross-study comparisons are limited by small sample sizes and differences in population, catheter techniques and imaging protocols. Interpretation of clinical impact is limited. Pain score recording and analgesic prescribing were not standardised, and patients frequently had multiple injuries requiring multimodal analgesia, making it difficult to isolate the contribution of erector spinae planes catheter position to pain relief. Furthermore, computed tomography demonstrates catheter location but may not reflect local anaesthetic spread or functional block efficacy. These findings highlight clinically relevant uncertainty regarding the relationship between catheter insertion technique, catheter position and patient-centred analgesic effectiveness. Further prospective studies are needed to determine whether insertion techniques affect catheter position, injectate spread and patient-centred analgesic outcomes.