EP056 Introduction of a thoracic trauma protocol including implementation of an erector spinae plane (ESP) catheter service in a busy district general hospital

Published Date: 24th September 2024

Publication Authors: Harwood. S, Ashe. M, Plant. K, Geetha. V, Senathirajah. A

Background and Aims
Following a previous audit into the management of rib fracture patients over 12 months (Jan-Dec 2021) an updated thoracic trauma protocol was introduced including offering a new ESP catheter service. We completed a re-audit of all rib fracture patients over a 12 month period to assess the impact, with audit department approval.

Methods
136 patients were identified presenting with rib fractures between October 2022 and September 2023. Data was collected from patient records on demographics, frailty, length of stay, rib fracture scores, type of analgesia, complications and appropriate referrals made. We also analysed those receiving ESP catheters in more detail (n=10).

Results
Our dataset showed significantly less patients requiring ventilation, and trends towards reduced length of stay, critical care admission, and chest infection (see table 1). More patients were routinely reviewed by critical care outreach and the pain team. Patients having ESP catheters showed lower pain scores after insertion (see table 2 and chart 1). Interpretation requires caution due to less bilateral fractures in the re-audit cohort.

Conclusions
Following introduction of an updated rib fracture protocol, including a new ESP catheter service, we have shown potential improvements in key outcomes but also faced challenges in implementation. During this transitional period we faced real-world hurdles including trialling different kits, procuring appropriate pumps, provision of relevant training for anaesthetists and ward staff, and gaining departmental buy-in. Despite this, results are promising and we hope that now it’s more established we can improve utilisation of the ESP service and our time to insertion prior to re-audit.

 

Harwood, S; Ashe, M; Plant, K; Geetha, V; Senathirajah, A. (2024). EP056 Introduction of a thoracic trauma protocol including implementation of an erector spinae plane (ESP) catheter service in a busy district general hospital – A re-audit with consideration of our real-world experience and challenges. Regional Anesthesia & Pain Medicine. 49(Suppl 1), p.A102. [Online]. Available at: https://doi.org/10.1136/rapm-2024-ESRA.129 [Accessed 12 December 2024]

 

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