Serratus Anterior Plane Block for Rib Fractures

Recruiting in Palo Alto (17 mi)

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase < 1

Recruiting

Sponsor: Rhode Island Hospital

Disqualifiers: Penetrating trauma, Pregnancy, Allergy, others

No Placebo Group

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

Trial 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

Participant Groups

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.

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.

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

Rhode Island Hospital Providence, RI

Who Is Running the Clinical Trial?

Rhode Island Hospital Lead Sponsor

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] Serratus anterior plane block (SAPB) was evaluated that in patients with the complaint of rib fracture pain in terms of total analgesic consumption and pain scores.

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

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

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] Ultrasound (US) guided serratus anterior plane block (SAPB) is a fascial plane block that has been utilized for managing pain after thoracotomy, mastectomy, and fractured ribs. We conducted this qualitative review to investigate the analgesic efficacy of US-guided SAPB in patients who sustained multiple rib fractures (MRFs). We registered our review proposal in a prospective register of systematic reviews, PROSPERO, with identifier CRD42020177145. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the identification, screening, and inclusion of relevant articles. Two authors independently searched Pubmed, Embase, the Cochrane Library, Google Scholar, and Web of Science to identify available randomized controlled trials (RCT), case reports, case series reports where SAPB was used for managing pain due to MRFs. Out of the 66 articles identified by the search strategy, 23 articles were assessed for eligibility, and 16 articles were included in the qualitative review. Due to significant heterogenicity, the presence of only one RCT, the presence of case report or series, availability of only retrospective studies for review, a quantitative analysis using statistical tests were not done. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment was not done as there was only one RCT in the review which had limitations like allocation concealment and blinding. US-guided SAPB is a safe and effective fascial plane block for managing pain in patients who sustain MRFs. Further research in the form of well-designed and adequately powered RCTs is needed to confirm its use in patients with MRFs.

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

[Continuous serratus anterior plane block provides analgesia in multiple rib fractures: a case report]. [2022] Thoracic trauma with rib fractures is a challenging condition due to the severe associated pain. Uncontrolled pain impairs breathing and an adequate pain control is necessary to provide comfort and to avoid further complications. Serratus Anterior Plane block is a procedure safe and easy to accomplish. The authors describe a case of thoracic trauma with rib fractures and respiratory compromise. Pain control was only achieved after performing a Serratus Anterior Plane block. The technique was done as described in the medical literature with placement of a catheter. Pain relief was achieved with a low concentration infusion of local anesthetic.

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] In patients with acute rib fractures, regional anesthesia has the potential to reduce suffering, decrease opiate use, lower rates of in-hospital delirium, and improve pulmonary function. While many regional anesthesia techniques are complex and time consuming, two single injection nerve blocks, the serratus anterior plane block and erector spinae plane block, are particularly fast, safe, and simple methods to anesthetize the chest wall. Herein we describe two cases in which the serratus anterior plane block and erector spinae plane block were each used with great success in achieving improved pain control in trauma patients with multiple rib fractures. We believe that any provider who routinely cares for patients with rib fractures (emergency physicians and trauma surgeons alike) can and should learn to use these straightforward nerve blocks.

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] The serratus anterior plane block (SAPB) is a safe, single-injection alternative for pain control in patients with rib fractures. This pilot study aims to teach the ultrasound-guided SAPB to emergency medicine (EM) residents using a mastery learning approach.

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] Rib fractures account for a significant number of emergency department visits each year. A patient's disposition often depends on the severity of rib fractures, comorbidities, and ability to achieve adequate analgesia. We present a 44-year-old male patient with severe pain secondary to rib fractures. The initial disposition was to admit for pain control. However, upon performing a serratus anterior plane block, patient was functionally appropriate for discharge with proper return precautions. Serratus anterior plane block is within the skillset of the emergency physician and can be used to achieve analgesia for rib fractures without the sedative and respiratory depressive effects associated with opioids.

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] We compared analgesia with an ultrasound (US)-guided serratus anterior plane block (SAPB) to thoracic epidural analgesia (EA) with continuous local anaesthetic infusion in patients with unilateral multiple traumatic rib fractures. EA often carries contraindications in patients with multiple rib fractures (MRFs), whereby having alternative effective methods to treat rib fracture pain remains important to patient care. Thus, we hypothesised that both regional anaesthetic techniques would provide effective pain relief.