Ultrasound-guided erector spinae plane block versus serratus anterior plane block for analgesia and respiratory function in patients with multiple rib fractures: a large-sample, single-center, randomized, double-blind, controlled trial - Report - MDSpire
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Ultrasound-guided erector spinae plane block versus serratus anterior plane block for analgesia and respiratory function in patients with multiple rib fractures: a large-sample, single-center, randomized, double-blind, controlled trial
Comparison of Ultrasound-Guided Erector Spinae Plane Block and Serratus Anterior Plane Block for Pain Relief and Respiratory Function in Patients with Multiple Rib Fractures
Overview
This study is a randomized controlled trial comparing the analgesic efficacy and respiratory function impact of ultrasound-guided erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in patients with multiple rib fractures (n=158). ESPB demonstrated superior pain relief and reduced opioid consumption compared to SAPB.
Background
Multiple rib fractures are a significant clinical challenge due to the associated severe pain and respiratory complications, with increased risks of pneumonia and respiratory failure. Effective pain management is crucial to prevent these complications. Regional analgesic techniques like ESPB and SAPB have emerged as promising alternatives to traditional opioid-based pain management.
Data Highlights
Outcome
ESPB (n=73)
SAPB (n=85)
p-value
24-h pain AUC
Lower (mean difference -17.78, 95% CI: -21.00 to -14.56)
Higher
<0.001
Opioid consumption
Reduced
Higher
<0.01
QoR-15 scores
Improved
Not improved
<0.01
Key Findings
ESPB provided significantly lower 24-h pain AUC compared to SAPB (mean difference -17.78, p < 0.001).
Both groups showed significant improvement in respiratory function, but no significant between-group differences were noted.
Analgesic superiority of ESPB was more pronounced in patients with ≤5 fractures (interaction p = 0.023).
Safety profiles and complication rates were comparable between the two techniques, with no significant adverse events reported.
Clinical Implications
ESPB may be considered a preferred first-line regional analgesic technique for patients with unilateral multiple rib fractures due to its superior pain relief and reduced opioid requirements. Clinicians should evaluate the number of fractures and other patient-specific factors when choosing between ESPB and SAPB.
Conclusion
ESPB offers better early analgesia and lower opioid consumption than SAPB for patients with multiple rib fractures, supporting its use in clinical practice without compromising safety. These findings highlight the need for tailored analgesic strategies in managing rib fractures.
