Ultrasound-Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures

Authors

Randy M. Kring, Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA.Follow
David C. Mackenzie, Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA.Follow
Christina N. Wilson, Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA.Follow
Joseph F. Rappold, Department of Surgery, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA.Follow
Tania D. Strout, Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA.Follow

Document Type

Article

Publication Date

11-2022

Institution/Department

Trauma & Acute Care Surgery; Emergency Medicine

Journal Title

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

MeSH Headings

Adult; Humans; Rib Fractures (complications, diagnostic imaging); Prospective Studies; Pain Measurement; Pain (etiology); Ultrasonography, Interventional; Pain, Postoperative

Abstract

OBJECTIVES: The serratus anterior plane block (SAPB) is an ultrasound-guided compartment block; limited data suggest that it can decrease pain in patients with rib fractures or chest wall pain. We sought to determine the effect of SAPB on pain and incentive spirometry (IS) maximal vital capacity in adult patients with rib fractures. METHODS: We enrolled a prospective sample of adult patients with at least two unilateral rib fractures who were being admitted for pain control. SAPB was performed by trained emergency physicians. Patients reported pain on an 11-point Numeric Rating Scale at rest and during IS, before, 15, and 60 minutes after SAPB. RESULTS: Mean pain scores decreased by 1.8 (SD 2.17, 95% confidence interval [CI]: 0.79-2.81) at 15 minutes and 2.5 (SD 2.69, 95% CI: 1.24-3.76) at 60 minutes. Compared to pre-block pain scores during IS, mean pain scores decreased by 1.95 (SD 1.99, 95% CI: 1.02-2.88) at 15 minutes and 2.4 (SD 2.42, 95% CI: 1.27-3.53) at 60 minutes. Mean maximum vital capacity increased by 232 mL (SD 406, 95% CI: 36-427) at 60 minutes. Zero SAPB-attributable complications were identified in the 24 hours post-enrollment. CONCLUSIONS: In patients with multiple rib fractures, SAPB reduced pain scores at rest and during IS, and increased maximal vital capacity. The SABP may be a safe and effective modality for pain control in trauma patients with multiple rib fractures.

First Page

2695

Last Page

2701

Recommended Citation

Kring RM, Mackenzie DC, Wilson CN, Rappold JF, Strout TD, Croft PE. Ultrasound-Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. J Ultrasound Med. 2022;41(11):2695-2701. doi:10.1002/jum.15953