Nerve Block for Rib Fractures

Overseen By Brent Becker, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: WellSpan Health

Must be taking: IV analgesia, oral opioids

Disqualifiers: Age <18, Allergy to anesthesia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: Up to 24 hours

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method to manage pain for individuals with multiple rib fractures. It compares a nerve block, the serratus anterior plane block (SAPB), to standard pain medications. Researchers aim to determine if the nerve block reduces pain and improves breathing more effectively than pain medications alone. Participants must have recent rib fractures diagnosed by X-ray or CT scan and require strong pain relief, such as IV or oral opioids. As an unphased trial, this study allows patients to contribute to innovative pain management research.

Do I have to stop taking my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on comparing a nerve block to pain medication, so you might continue your current meds, but it's best to confirm with the trial coordinators.

What prior data suggests that the serratus anterior plane block is safe for patients with rib fractures?

Research shows that the serratus anterior plane block (SAPB) is generally safe for people with broken ribs. In studies, SAPB reduced pain and eased breathing for patients. Most people handled the treatment well, and no serious problems occurred.

One study with 156 patients showed that SAPB effectively reduced pain. Another study found that SAPB improved pain control for up to 6 hours after the procedure, reducing the need for pain medication.

Overall, research suggests that SAPB is a promising option for managing pain from rib fractures. It appears well-tolerated with few issues. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Serratus Anterior Plane Block (SAPB) for rib fractures because it offers a targeted approach to pain management, which is different from standard analgesic medications. Unlike traditional treatments that often rely on systemic painkillers, SAPB involves a nerve block technique that provides localized pain relief by numbing specific nerves around the rib area. This method can potentially reduce the need for high doses of oral medications, minimizing side effects and promoting faster recovery. Additionally, the SAPB may offer quicker and more effective pain relief, which is crucial for improving patients' comfort and mobility after rib fractures.

What evidence suggests that the serratus anterior plane block is effective for rib fractures?

Research has shown that the serratus anterior plane block (SAPB), which participants in this trial may receive, can greatly reduce pain from broken ribs. Studies indicate that adding SAPB to regular pain treatments often results in better pain relief and less need for opioid medications. Patients who receive SAPB also tend to breathe better. The SAPB is generally safe and effective for managing pain from rib injuries. Overall, it appears to be a promising option for improving comfort in people with broken ribs. ^{1 2 5 6 7}

Who Is on the Research Team?

Daniel Kreider, MD

Principal Investigator

WellSpan Health

Are You a Good Fit for This Trial?

This trial is for adults over 18 with one or more rib fractures confirmed by X-ray or CT scan, who visit WellSpan York Hospital's ED and need IV painkillers or oral opioids. It excludes those under 18, unable to consent, allergic to local anesthesia, needing urgent surgery, discharged immediately, revisiting for the same injury, or with other major injuries.

Inclusion Criteria

I am older than 18 years.

>1 Unilateral, acute rib fractures diagnosed on x-ray or CT imaging

Patient presenting to the WellSpan York Hospital ED

Exclusion Criteria

I have severe injuries that pain medication for the chest wouldn't help.

Allergy to local anesthesia

I am visiting for a follow-up on my rib fractures.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Treatment

Participants receive either serratus anterior plane block (SAPB) or standard analgesic medications in the emergency department

Up to 24 hours

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including pain scores and adverse outcomes

30 days

1 phone call at 1 week, electronic medical record review at 30 days

What Are the Treatments Tested in This Trial?

Interventions

• Serratus Anterior Plane Block (SAPB)
• Standard Analgesic Medications

Trial Overview The study compares a pain relief technique called Serratus Anterior Plane Block (SAPB) guided by ultrasound against standard pain medications in patients with multiple rib fractures. The focus is on pain management effectiveness and overall patient outcomes like medication use and hospital stay length.

How Is the Trial Designed?

Group I: Serratus Anterior Plane Block Experimental Treatment 2 Interventions

Subjects will undergo serratus anterior plane block, in addition to standard of care analgesic medications at the discretion of the treatment team.

Group II: Standard Analgesic Medications Active Control 1 Intervention

Subjects will receive standard of care analgesic medications at the discretion of the treatment team.

Serratus Anterior Plane Block (SAPB) is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Serratus Anterior Plane Block for:

• Rib fractures
• Chest wall pain

Approved in European Union as Serratus Anterior Plane Block for:

• Rib fractures
• Thoracic surgery pain

Approved in Canada as Serratus Anterior Plane Block for:

• Rib fractures
• Chest wall pain

Who Is Running the Clinical Trial?

WellSpan Health

Lead Sponsor

Trials

32

Recruited

2,005,000+

Published Research Related to This Trial

The bilateral ultrasound-guided serratus anterior plane block (SAPB) effectively relieved severe pain in a 72-year-old male with deep partial-thickness burns, providing complete pain resolution for about 15 hours.

This case suggests that SAPB can be a valuable part of a multimodal analgesic approach for managing pain in patients with superficial and partial-thickness burns on the anterior chest wall.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case Report: Bilateral Ultrasound-guided Serratus Anterior Plane Blocks for a Chest Wall Burn. Benesch, T., Mantuani, D., Nagdev, A.[2021]

In a study of 60 patients with rib fractures, the serratus anterior plane block (SAPB) significantly reduced total tramadol consumption and pain scores compared to the control group, indicating its effectiveness in managing acute pain.

Patients receiving SAPB reported lower rates of chronic pain at rest and during activity, suggesting that this technique not only alleviates immediate pain but may also help prevent long-term pain issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Analgesic efficacy of the serratus anterior plane block in rib fractures pain: A randomized controlled trial. Tekşen, Ş., Öksüz, G., Öksüz, H., et al.[2021]

The study successfully trained 28 emergency medicine residents to perform the serratus anterior plane block (SAPB) using a mastery learning approach, with all participants achieving mastery by scoring 17 out of 19 items correctly on a checklist after training.

Residents reported a significant increase in confidence regarding the SAPB procedure, moving from a median score of 2 to 5 on a 5-point scale, indicating that the training effectively improved both skills and self-assurance in performing this pain control technique.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using a Simulated Model and Mastery Learning Approach to Teach the Ultrasound-guided Serratus Anterior Plane Block to Emergency Medicine Residents: A Pilot Study. Rider, AC., Miller, DT., Ashenburg, N., et al.[2022]

The serratus anterior plane block (SAPB) can be safely and efficiently performed in the emergency department for patients with multiple rib fractures, with a median procedure time of just 5.5 minutes and 80% completed in a single attempt.

Patients experienced a significant reduction in pain scores from 6.5 to 3 within 4 hours after the SAPB, and no complications were reported, suggesting that this technique could be a valuable addition to pain management protocols in trauma settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Regional anaesthesia for rib fractures: A pilot study of serratus anterior plane block. Schnekenburger, M., Mathew, J., Fitzgerald, M., et al.[2021]

The serratus anterior plane block (SAPB) significantly reduced pain in patients with multiple rib fractures, with mean pain scores decreasing by 1.8 at 15 minutes and 2.5 at 60 minutes after the procedure.

SAPB also improved lung function, as indicated by a mean increase in maximal vital capacity of 232 mL at 60 minutes, and no complications were reported within 24 hours, suggesting it is a safe and effective pain management option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Kring, RM., Mackenzie, DC., Wilson, CN., et al.[2022]

In a case series of 10 patients with multiple rib fractures experiencing severe pain, ultrasound-guided serratus anterior plane block (SAPB) significantly reduced pain scores by a median of 5 points within 30 minutes and 7.5 points after 60 minutes.

The technique was safely administered by trained emergency physicians, with no reported block failures or complications, indicating its potential as an effective pain management option for rib fracture patients in the emergency department.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-Guided Serratus Anterior Plane Block for Rib Fracture-Associated Pain Management in Emergency Department. Paul, S., Bhoi, SK., Sinha, TP., et al.[2022]

In a study of 72 patients with multiple rib fractures, those receiving continuous serratus anterior plane block (SAPB) experienced significantly lower pain scores and reduced fentanyl consumption compared to those treated with fentanyl alone.

The use of ultrasound-guided SAPB was found to be safe, with no complications reported, and it offers an effective, opioid-sparing pain management option that can enhance recovery and facilitate early mobilization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A retrospective study comparing analgesic efficacy of ultrasound-guided serratus anterior plane block versus intravenous fentanyl infusion in patients with multiple rib fractures. Diwan, S., Nair, A.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8848750/

Efficacy of Ultrasound-Guided Serratus Anterior Plane ... The results indicated that US-guided SAPB could significantly decrease the postoperative pain score and opioids requirement and is safe without ...

2. jamanetwork.com jamanetwork.com/journals/jamasurgery/fullarticle/2818238

Serratus Anterior Plane Blocks for Early Rib Fracture Pain ... This randomized clinical trial found that the addition of an SAPB to standard care significantly increased the proportion of patients with rib fractures who ...

3. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39020130/

Efficacy and safety of the serratus anterior plane block ... Conclusion: The SAP block, in combination with standard therapy, appeared to be more effective in providing pain relief than standard therapy ...

4. tsaco.bmj.com tsaco.bmj.com/content/9/1/e001183

Serratus anterior plane block improves pain and incentive ... Patients with rib fractures who received SAPB as part of a multimodal pain control strategy had a greater improvement in pain and respiratory function

5. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/jum.15953

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) ... Our data support the use of the SAPB as an effective adjunct for pain control in patients with multiple anterior and lateral rib fractures.

6. journals.lww.com journals.lww.com/clinicalpain/abstract/9900/efficacy_and_safety_of_serratus_anterior_plane.294.aspx

Efficacy and Safety of Serratus Anterior Plane Block and... The results indicated that FPBs outperformed standard care in relieving pain for up to 6 hours post-block (standardized mean difference [SMD]:− ...

7. bmcanesthesiol.biomedcentral.com bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-025-03000-6

Comparison of the analgesic efficacy of ultrasound-guided ... S-SAPB provides prolonged analgesia and may be preferable for managing rib fracture pain beyond the initial 8 h. However, ICNB offers superior pain relief.