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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new method for managing pain in individuals with rib fractures. Researchers aim to determine if the Serratus Anterior Plane Block, which numbs the nerves around the ribs using ultrasound, can reduce pain and improve lung function compared to standard care. They will also assess whether this method reduces the need for opioids, strong pain medications, within the first day after a rib injury. Individuals with rib fractures confirmed by X-ray or CT scan, who experience significant pain and can follow simple breathing instructions, may be suitable for this trial. As an Early Phase 1 trial, this research focuses on understanding how the treatment works in people, offering participants the opportunity to be among the first to receive this innovative approach.

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 prior data suggests that the Serratus Anterior Plane Block is safe for patients with rib fractures?

Research has shown that the Ultrasound Guided Serratus Anterior Plane Block (SAPB) is generally safe for people with broken ribs. Studies have found that patients who received SAPB experienced less pain both at rest and during breathing exercises. Importantly, none of these studies reported any serious side effects from the treatment.

In another study, SAPB was part of a pain management plan, and patients experienced better pain relief and improved breathing. These results suggest that SAPB is a safe way to manage pain for people with rib fractures. Although this trial is still in the early stages, existing research supports its safety for this purpose. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the ultrasound-guided Serratus Anterior Plane Block (SAPB) for rib fractures because it offers a targeted pain management approach. Unlike traditional methods such as systemic opioids or nerve blocks that can affect a larger area of the body, SAPB specifically targets the nerves supplying the ribs, potentially reducing side effects and improving pain relief. This technique could provide faster pain relief with fewer complications, making it an attractive alternative to current pain management options for rib fractures.

What evidence suggests that the Serratus Anterior Plane Block is effective for rib fractures?

Research shows that the Ultrasound Guided Serratus Anterior Plane Block (SAPB) helps manage pain for people with rib fractures. In this trial, participants in the intervention arm will receive SAPB, which studies have found greatly improves pain relief and breathing when added to regular treatment. Specifically, one study found that patients who received SAPB experienced less pain and could breathe better than those who did not. The SAPB method is a safe and effective way to reduce pain, potentially decreasing the need for opioid medications. Overall, evidence suggests that SAPB can lead to better outcomes for those with rib fractures. ^{2 6 7 8 9}

Are You a Good Fit for This Trial?

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

Known allergy to amide-type local anesthetics

Penetrating trauma

I need surgery or a procedure right away.

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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 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]

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]

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]

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]

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]

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]

Citations

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

Efficacy of Ultrasound-Guided Serratus Anterior Plane ... US-guided SAPB is a safe and effective fascial plane block for managing pain in patients who sustain MRFs.

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. 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

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11905462/

Comparison of the analgesic efficacy of ultrasound ... This randomized controlled trial demonstrated that both S-SAPB and ICNB are effective analgesic techniques for rib fractures. However, their efficacy varies ...

5. clinicaltrials.gov clinicaltrials.gov/study/NCT03619785

NCT03619785 | US-guided SAPB for Rib Fractures in the ED The purpose of this randomized controlled study is to determine whether the serratus anterior plane block reduces pain more than the usual treatment for rib ...

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/35106815/

Ultrasound-Guided Serratus Anterior Plane Block (SAPB) ... In patients with multiple rib fractures, SAPB reduced pain scores at rest and during IS, and increased maximal vital capacity.

7. annemergmed.com annemergmed.com/article/S0196-0644(21)01083-0/fulltext

230 Ultrasound-Guided Serratus Anterior Plane Block ... Conclusion. In patients with multiple rib fractures, SAPB reduced pain scores at rest and during incentive spirometry, and increased maximal vital capacity. The ...

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

Comparison of the analgesic efficacy of ultrasound-guided ... This study aimed to compare the analgesic efficacy of ultrasound-guided superficial serratus anterior plane block (S-SAPB) and intercostal nerve ...

9. clinicaltrials.gov clinicaltrials.gov/study/NCT03619785

NCT03619785 | US-guided SAPB for Rib Fractures in the ED The purpose of this randomized controlled study is to determine whether the serratus anterior plane block reduces pain more than the usual treatment for rib ...