Serratus Anterior Plane Block for Rib Fractures

Overseen By Leland K Perice, MD

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: Rhode Island Hospital

Disqualifiers: Penetrating trauma, Pregnancy, Allergy, others

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

Compensation: Varies

Number of Visits: 1

Duration: 5 hours

40 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this clinical trial is to test the effectiveness of the Serratus Anterior Plane Block in patients with rib fractures. The main questions it aims to answer are: * Determine if UG-SAPB results in an improved pain, incentive spirometry, and cough ability (PIC) score when compared to usual care over the first five hours. * Evaluate if UG-SAPB results in fewer opioid medications administered when compared to usual care over the first 24 hours. Participants will undergo the Serratus Anterior Plane. Researchers will compare this to usual care to see if this intervention improves pulmonary function and reduces opioid requirements for ED patients with rib fractures.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Ultrasound Guided Serratus Anterior Plane Block for rib fractures?

Research shows that the serratus anterior plane block (SAPB) is effective in managing pain from rib fractures, reducing the need for other pain medications, and improving breathing by controlling pain. It is considered safe and easy to perform, with studies and case reports indicating successful pain relief in patients with rib fractures. ^{1 2 3 4 5}

Is the serratus anterior plane block safe for humans?

The serratus anterior plane block is considered a safe method for pain control in patients with rib fractures, as it avoids the sedative and respiratory depressive effects associated with opioids. ^{1 3 5 6 7}

How does the serratus anterior plane block treatment differ from other treatments for rib fractures?

The serratus anterior plane block is unique because it is a regional anesthesia technique that provides pain relief by numbing the nerves around the ribs, using ultrasound guidance to ensure precision. Unlike more complex procedures, it is quick, safe, and can be easily performed by clinicians, offering an alternative to traditional methods like epidural analgesia, which may not be suitable for all patients. ^{1 2 4 5 8}

Eligibility Criteria

This trial is for emergency department patients with rib fractures. It's designed to see if a regional anesthesia technique called the Serratus Anterior Plane Block can help manage pain better and reduce opioid use compared to standard care.

Inclusion Criteria

My pain level is at least a 5 out of 10.

I can rate my pain on a scale from 0 to 10.

I can use a breathing device and cough when asked.

Exclusion Criteria

I need surgery or a procedure right away.

Known allergy to amide-type local anesthetics

Penetrating trauma

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive the Serratus Anterior Plane Block and are monitored for pain, incentive spirometry, and cough ability (PIC) score over the first five hours

5 hours

1 visit (in-person)

Immediate Follow-up

Participants are monitored for opioid medication usage over the first 24 hours

24 hours

Follow-up

Participants are monitored for safety and effectiveness after treatment

1-2 weeks

Treatment Details

Interventions

• Ultrasound Guided Serratus Anterior Plane Block

Trial Overview The study tests the effectiveness of Ultrasound Guided Serratus Anterior Plane Block (UG-SAPB) on improving pain, breathing function, and coughing ability, as well as decreasing the need for opioid painkillers in patients with broken ribs.

Participant Groups

Group I: Intervention arm (Undergoes SAPB) Experimental Treatment 2 Interventions

Patients randomized to this arm will receive the Serratus Anterior Plane block.

Group II: Control Active Control 1 Intervention

Usual care. No changes made or recommended to patients randomized to the control arm.

Who Is Running the Clinical Trial?

Rhode Island Hospital

Lead Sponsor

Trials

275

Recruited

71,400+

Findings from Research

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 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]

Ultrasound-guided serratus anterior plane block (SAPB) is a safe and effective method for managing pain in patients with multiple rib fractures, as indicated by a qualitative review of 16 studies.

The review highlighted the need for more rigorous randomized controlled trials (RCTs) to confirm the efficacy of SAPB, given that only one RCT was included and it had limitations in its design.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Managing Pain Due to Multiple Rib Fractures: A Scoping Review. Nair, A., Diwan, S.[2022]

The Serratus Anterior Plane block is a safe and effective method for managing severe pain associated with rib fractures in thoracic trauma, which is crucial for improving breathing and preventing complications.

In a reported case, pain control was successfully achieved using this technique with a catheter and a low concentration infusion of local anesthetic, highlighting its practical application in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Continuous serratus anterior plane block provides analgesia in multiple rib fractures: a case report]. Camacho, FCO., Segura-Grau, E.[2022]

Regional anesthesia techniques, specifically the serratus anterior plane block and erector spinae plane block, are effective and simple methods for managing pain in patients with acute rib fractures, leading to improved pain control.

These nerve blocks not only reduce the need for opioids but also have the potential to decrease in-hospital delirium and enhance pulmonary function, making them beneficial for trauma patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Single injection, ultrasound-guided planar nerve blocks: An essential skill for any clinician caring for patients with rib fractures. Schultz, C., Yang, E., Mantuani, D., et al.[2022]

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]

A serratus anterior plane block effectively managed severe pain in a 44-year-old male patient with rib fractures, allowing for discharge instead of hospital admission.

This technique provides a safe alternative to opioids for pain relief, minimizing risks of sedation and respiratory depression, which is particularly beneficial in emergency settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serratus anterior plane block as a bridge to outpatient management of severe rib fractures: a case report. Lee, JB., Nelson, A., Lahham, S.[2022]

In a study of 59 patients with unilateral multiple rib fractures, both ultrasound-guided serratus anterior plane block (SAPB) and thoracic epidural analgesia (EA) provided significant pain relief, but EA was more effective in reducing pain during movement in the first 12 hours after the procedure.

SAPB is a viable alternative for pain management in patients where EA is contraindicated, as it effectively reduces pain levels, although it may not provide as rapid relief as EA initially.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An ultrasound-guided serratus anterior plane block with continuous local anaesthetic infusion and epidural analgesia for rib fracture pain. Lundén, AR., Tarkkila, P.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Analgesic efficacy of the serratus anterior plane block in rib fractures pain: A randomized controlled trial. [2021]

2. Australia pubmed.ncbi.nlm.nih.gov

Regional anaesthesia for rib fractures: A pilot study of serratus anterior plane block. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Managing Pain Due to Multiple Rib Fractures: A Scoping Review. [2022]

4. Brazil pubmed.ncbi.nlm.nih.gov

[Continuous serratus anterior plane block provides analgesia in multiple rib fractures: a case report]. [2022]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Single injection, ultrasound-guided planar nerve blocks: An essential skill for any clinician caring for patients with rib fractures. [2022]

6. United States 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. [2022]

7. Korea (South) pubmed.ncbi.nlm.nih.gov

Serratus anterior plane block as a bridge to outpatient management of severe rib fractures: a case report. [2022]

8. England pubmed.ncbi.nlm.nih.gov

An ultrasound-guided serratus anterior plane block with continuous local anaesthetic infusion and epidural analgesia for rib fracture pain. [2023]