Serratus Anterior Plane Block for Acute Rib Fractures in the Emergency Department: A Randomized Controlled Trial

Area of Science:

• Emergency Medicine
• Pain Management
• Regional Anesthesia

Background:

• Acute rib fractures present significant pain management challenges in the emergency department.
• Current standard care includes multimodal analgesia and pulmonary hygiene.
• The Serratus Anterior Plane Block (SAPB) is a bedside procedure with a favorable risk profile for rib fracture analgesia.

Purpose of the Study:

• To investigate if SAPB performed by emergency medicine physicians improves pain, inspiratory capacity, and cough (PIC) scores in acute rib fracture patients.
• To compare the effectiveness of SAPB plus usual care versus usual care alone.

Main Methods:

• A prospective, open-label, randomized controlled trial was conducted at an academic Level 1 Trauma Center.
• Adult patients with rib fractures (T2-T9) and pain score ≥5 were randomized to SAPB + usual care or usual care alone.
• The primary outcome was improvement in PIC score; secondary outcome was 24-hour oral morphine equivalents (OMEs).

Main Results:

• The SAPB group showed a significant improvement in PIC scores at 5 hours post-enrollment (p=0.03).
• The intervention group received fewer OMEs at 24 hours (32.2 mg vs. 54.1 mg), though this was not statistically significant (p=0.44).
• No complications were observed in the SAPB group.

Conclusions:

• Adding SAPB to usual care significantly improved PIC scores in ED patients with rib fractures.
• SAPB was safely performed by emergency physicians, demonstrating feasibility and scalability.
• SAPB is a valuable adjunct for acute rib fracture analgesia in the emergency department.