Objective:

To compare the analgesic efficacy and impact on respiratory function of ultrasound-guided erector spinae plane block (ESPB) versus serratus anterior plane block (SAPB) in patients with unilateral multiple rib fractures, highlighting the clinical significance of this comparison.

Key Findings:

• ESPB group had a significantly lower 24-h pain AUC compared to SAPB (mean difference −17.78, p < 0.001).
• ESPB significantly reduced 24-h opioid consumption and improved QoR-15 scores (both p < 0.01).
• No significant between-group differences in respiratory function parameters were found.
• Analgesic superiority of ESPB was more pronounced in patients with ≤5 fractures (interaction p = 0.023).

Interpretation:

ESPB provides significantly better early comprehensive analgesia and reduces opioid requirements compared to SAPB, without compromising safety, which has important implications for clinical practice.

Limitations:

• Single-center study may limit generalizability; further multicenter studies are needed to validate findings.
• Results may vary based on fracture characteristics not fully explored, which could affect the applicability of the results.

Conclusion:

ESPB may be considered as a preferred first-line regional analgesic technique for patients with unilateral multiple rib fractures, especially for those with a lower fracture burden, emphasizing the need for effective pain management strategies.