Serratus Anterior Plane Block Linked to Improved Pain Control in Patients Wiith Rib Fractures
In a multicenter randomized clinical trial published in JAMA Surgery, patients with rib fractures who received a serratus anterior plane block (SAPB) in addition to standard care were more than twice as likely to experience early favorable pain relief compared with those receiving standard care alone.
Rib fractures due to blunt thoracic trauma are associated with intense pain that is often difficult to manage. Effective pain control is critical not only for patient comfort but also for reducing complications such as pneumonia and prolonged hospitalization. While regional anesthesia techniques like SAPB have shown promise in thoracic procedures, evidence supporting their use specifically for rib fractures has been limited. This study aimed to address that gap.
Researchers conducted an open-label, pragmatic randomized trial across eight emergency departments between April 2021 and January 2022. The trial included patients aged 16 years or older with clinically suspected or radiologically confirmed rib fractures. Exclusion criteria included intubation, urgent surgical needs, or major non-thoracic injuries. Patients were randomized in a 1:1 ratio to receive either SAPB plus standard care or standard care alone. The primary outcome was a composite pain score measured 4 hours after enrollment, defined as both a two-point reduction in pain and an absolute pain score of less than four on a 10-point scale.
Out of 588 patients screened, 210 were enrolled and evenly randomized between the two study arms. The median patient age was 71 years, and 62% were men. At 4 hours post-enrollment, 41% of patients in the SAPB group met the composite pain outcome compared with 19.6% in the control group. The SAPB group also required significantly fewer opioids in the first 24 hours, with a median total opioid requirement of 45 mg morphine equivalents versus 91 mg in the control group.
In the intention-to-treat analysis of complete cases, the composite pain score outcome was achieved by 38 of 92 patients (41%) in the SAPB group, compared with 18 of 92 (19.6%) in the control group (relative risk, 0.73; 95% CI, 0.60-0.89; P = .001). The SAPB group also had lower median 24-hour opioid use and similar outcomes in terms of pneumonia rates, hospital length of stay, and 30-day mortality.
“This randomized clinical trial found that the addition of an SAPB to standard rib fracture care significantly increased the proportion of patients who experienced a meaningful reduction in their pain score while also reducing in-hospital opioid requirements,” the authors concluded.
Reference
Partyka C, Asha S, Berry M, Ferguson I, Burns B, Tsacalos K, Gaetani D, Oliver M, Luscombe G, Delaney A, Curtis K. Serratus anterior plane blocks for early rib fracture pain management: The SABRE randomized clinical trial. JAMA Surg. 2024;159(7):810-817. doi:10.1001/jamasurg.2024.0969