Regional anaesthesia for rib fractures: A pilot study of serratus anterior plane block

Rib fractures are not only painful but are associated with morbidity and mortality, especially in older patients. The serratus anterior plane block (SAPB) is a plane block distant from major neurovascular bundles and may provide anaesthesia to a substantial area of the hemithorax. This pilot study was designed to assess if the SAPB can be safely and efficiently incorporated to the trauma reception workflow of an adult, level 1 trauma centre.

A convenience sample of 20 adult patients with at least two or more unilateral rib fractures received a SAPB performed by an emergency physician in addition to their standard analgesic regime. Time to perform the procedure, the number of attempts and complications were recorded as feasibility measures. Secondary outcome was the safety of the block. Numerical pain scores at pre-determined time points over 4 h, the diagnosis of hospital-acquired pneumonia, hospital length of stay and mortality at hospital discharge were collected to provide pilot data on effectiveness.

The median time to perform the procedure was 5.5 (interquartile range 4.6-10) mins with a range of 2-10.5 min. Most (16; 80%) SAPBs were completed in a single attempt. There were no documented complications. Median pain scores reduced from 6.5 (6-8) and were maintained at 3 (2-5) at 4 h after the SAPB.

The present study demonstrated the feasibility of ultrasound-guided SAPB among patients with multiple rib fractures in the ED. No complications were observed. Further prospective evaluation of analgesic effects in a larger cohort is indicated.