Ultrasound-Guided Serratus Anterior Plane Block in Emergency Department Patients With Rib Fractures

Here, we evaluate the effectiveness of the UG-SAPB performed in ED patients with pain primarily from rib fractures using a randomized controlled trial study design. This is a single-center, prospective, randomized controlled trial. Patients were randomized into one of two study arms: UG-SAPB in addition to usual care or usual care. Blinded research assistants then assessed PIC scores at 0, 2, and 5 hours. The PIC score is a composite of the patient’s pain, incentive spirometry, and cough strength. PIC score is a validated tool that can predict which patients with rib fractures require intensive care unit level of care and can be serially assessed to monitor the progression of a patient’s pulmonary functional status. We also assessed the total amount of oral morphine equivalents (OME) each patient received within 24 hours after enrollment.

Thirteen percent of rib fractures are complicated by pneumonia, empyema, ARDS, or aspiration. Many of these complications occur because of changes in breathing dynamics that occur due to fracture pain, which impairs clearance of airway secretions. The current standard of care is aimed at achieving pain control to prevent these complications. This is primarily done through opioids and Non-Steroidal Anti-Inflammatory Drugs (NSAIDS). However, there are contraindications to both of these medications in a large number of patients. The Ultrasound-guided Serratus Anterior Block (UG-SAPB) presents a viable alternative to NSAIDs and opioids that can provide pain relief in nearly all emergency department (ED) patients with rib fractures. Our objective is to test the hypothesis that the UG-SAPB improves pulmonary function for ED patients with rib fractures and reduces the amount of opioids they receive.

We enrolled 38 patients, with 19 in each study arm. Both groups had a similar number of rib fractures, with an average of 4.68 in the control and 4.65 in the treatment arm. We found the PIC scores to improve in the intervention arm by .9 at 2 hours and 1.4 at 5 hours (P=

Patients who underwent the UG-SAPB in the ED had improved clinical outcomes as measured by the PIC score and received half as many opioids as patients who received usual care alone. These results support the use of the UG-SAPB in ED patients with rib fractures.