Serratus Anterior Plane Block for Improving Pain and Respiratory Function in Patients With Multiple Rib Fractures

Completed

• Conditions: Rib Fracture Multiple
• Interventions: Other: Serratus Anterior Plane Block

• Registration Number: NCT04311827
• Lead Sponsor: Stanford University

Brief Summary

This is an observational study which will evaluate the efficacy of the serratus anterior plane block for treating pain and respiratory capacity in patients with multiple rib fractures. When resources are available for a SAPB to be performed, patients will receive this block in addition to traditional pain medications, while at other times, patients will receive traditional pain medications only.

Detailed Description

Pain management by systemic analgesics and by nerve blocks are both standard of care and used in Emergency Department (ED) depending on the resources available. Not all ED physicians are trained or comfortable with the serratus anterior nerve block and thus it is not always available to patients and is provider dependent.

This is an observational study where patients with multiple rib fractures will receive either a serratus anterior plane block (SAPB) in addition to traditional forms of pain control when providers trained to perform the block are available, or will receive traditional forms pain control if trained personnel are not available. In addition to the serratus anterior plane block, standard forms of pain control in the Stanford Emergency Department include: oral or parenteral acetaminophen, oral or parenteral NSAIDs, oral or parenteral opiates, parenteral lidocaine, and parenteral ketamine.

Retrospective evaluation of the allocation of patients to either nerve block or no nerve block will be dictated by physician ability, time and resources to do the block. The efficacy of the block will be evaluated by serial measurements of pain score and respiratory capacity.

Study Timeline

• Study Start: 2020-03-03
• Study First Submitted: 2020-03-10
• Study First Submitted QC: 2020-03-15
• Study First Posted: 2020-03-17
• Primary Completion: 2021-12-31
• Study Completion: 2021-12-31
• Status Verified: 2022-08
• Last Update Submitted: 2022-08-23
• Last Update Posted: 2022-08-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 39

Inclusion Criteria

1. Age greater or equal to 18 years of age
2. Presentation to Stanford University Hospital Emergency Department within 12 hours of a traumatic incident
3. Three or more anterior and/or lateral unilateral rib fractures diagnosed by CT
4. GCS 15, with the ability to discern and describe pain from rib fractures and give consent
5. Presentation to the Emergency Department between 7am and 11pm (for identification by research assistants)

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Exclusion Criteria

1. Posterior rib fractures
2. Bilateral rib fractures
3. Sternal fracture
4. Known allergy to local anesthetics
5. Pregnancy
6. Significant coagulopathy
7. Hemodynamic instability

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Serratus anterior plane block and traditional analgesia	Serratus Anterior Plane Block	Serratus anterior plane block (Bupivacaine 75mg injected into facial plane once) Acetaminophen 1000mg IV every 6 hours as needed Toradol 15mg IV every 6 hours as needed Morphine 4mg every 2 hours as needed Hydromorphone 0.5mg IV every 2 hours as needed

Primary Outcome Measures

Name	Time	Method
Change in pain score	Before and 3 hours after analgesia administration	Patient reported pain score from 0-10 (0 - no pain, 10 = worst pain imaginable).
Change in incentive spirometry volume	Before and 3 hours after analgesia administration	Maximum inspiratory respiratory volume (measured in ml) recorded on single use of incentive spirometer device

Secondary Outcome Measures

Name	Time	Method
Analgesia administration	Up to 3 days	Dosage of analgesic medications administered for pain during ED visit and hospital stay

Trial Locations

Locations (1)

Stanford University Hospital; 🇺🇸 Palo Alto, California, United States