Reviews
5 August 2025
Vol. 1 No. 1 (2023)
Serratus plane block and erector spinae plane block in the management of pain associated with rib fractures in chest trauma: a brief report from a single-center
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
1639
Views
250
Downloads
Authors
Pain harms the clinical course of individuals with rib fractures. Patients with more than three fractured ribs are more likely to have lung problems because pain can impede lung ventilation and secretion clearance due to difficulty coughing, resulting in atelectasis and hypoxia. Systemic analgesia to invasive regional anesthesia procedures such as thoracic epidural, paravertebral catheters, intercostal nerve blocks, and fascial plane blocks are all alternatives for analgesia in chest trauma. The study’s goal is to evaluate the analgesic efficacy of erector spinae plane (ESP) and serratus anterior plane (SAP) blocks in chest injuries, as well as their effect on improving respiratory metrics. For this objective, fifteen cases of isolated thoracic trauma resulting in rib fractures were reviewed retrospectively. All patients were at least 18 years old, spontaneously breathing, and had received a chest wall fascial plane block for pain relief. All patients reported practically instantaneous pain alleviation, with the onset occurring around 10 minutes after the block operation. One patient required oxygen therapy, but the rest were quickly weaned due to improved respiratory mechanics. Our findings suggest that chest wall anesthetic blocks are a safe and effective therapy for pain caused by rib fractures. At admission, the median NRS was 7 (RF 6:26.7%; 7:26.7%; 8:26.7%; 9:13.3%; 10:6.7%), with a minimum of 6 and a maximum of 10 (IQR: 1.5, CV: 0.2). All patients reported immediate pain relief that began around 10 minutes after the block was done; the average decrease in NRS was 6.8 points. They have also been shown to be effective and beneficial in improving respiratory parameters and lowering oxygen support.
Altmetrics
Downloads
Download data is not yet available.
Citations
Martin TJ, Eltorai AS, Dunn R, et al. Clinical management of rib fractures and methods for prevention of pulmonary complications: A review. Injury 2019;50:1159-65. DOI: https://doi.org/10.1016/j.injury.2019.04.020
Prins JTH, Van Lieshout EMM, Overtoom HCG, et al. Long-term pulmonary function, thoracic pain, and quality of life in patients with one or more rib fractures. J Trauma Acute Care Surg. 2021;91:923-31. DOI: https://doi.org/10.1097/TA.0000000000003378
Simon BJ, Cushman J, Barraco R, et al. Pain management guidelines for blunt thoracic trauma. J Trauma 2005;59:1256-67. DOI: https://doi.org/10.1097/01.ta.0000178063.77946.f5
Unsworth A, Curtis K, Asha SE. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Scand J Trauma Resusc Emerg Med 2015;23:17. DOI: https://doi.org/10.1186/s13049-015-0091-5
Rogers FB, Larson NJ, Rhone A, et al. Comprehensive review of current pain management in rib fractures with practical guidelines for clinicians. J Intensive Care Med 2023;38:327-39. DOI: https://doi.org/10.1177/08850666221148644
Craxford S, Owyang D, Marson B, et al. Surgical management of rib fractures after blunt trauma: a systematic review and meta-analysis of randomised controlled trials. Ann R Coll Surg Engl 2022;104:249-56.
Simon JB, Wickham AJ. Blunt chest wall trauma: an overview. Br J Hosp Med (Lond) 2019;80:711-5. DOI: https://doi.org/10.12968/hmed.2019.80.12.711
Mackersie RC, Karagianes TG, Hoyt DB, Davis JW. Prospective evaluation of epidural and intravenous administration of fentanyl for pain control and restoration of ventilatory function following multiple rib fractures. J Trauma 1991;31:443-9. DOI: https://doi.org/10.1097/00005373-199104000-00002
Moon MR, Luchette FA, Gibson SW, et al. Prospective, randomized comparison of epidural versus parenteral opioid analgesia in thoracic trauma. Ann Surg 1999;229:684-91. DOI: https://doi.org/10.1097/00000658-199905000-00011
Pape HC, Remmers D, Rice J, et al. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma 2000;49:496-504. DOI: https://doi.org/10.1097/00005373-200009000-00018
Bulger EM, Edwards T, Klotz P, Jurkovich GJ. Epidural analgesia improves outcome after multiple rib fractures. Surgery 2004;136:426-30. DOI: https://doi.org/10.1016/j.surg.2004.05.019
Topçu I, Ekici Z, Sakarya M. Toraks travmali hastalarda intravenöz hasta kontrollü analjezi ile torakal epidural hasta kontrollü analjezinin klinik etkinliğinin karşilaştirilmasi [Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit]. Ulus Travma Acil Cerrahi Derg 2007;13:205-10. Turkish.
Yeung JH, Gates S, Naidu BV, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev 2016;2:CD009121. DOI: https://doi.org/10.1002/14651858.CD009121.pub2
Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth 2011;107:859-68. DOI: https://doi.org/10.1093/bja/aer339
Malchow RJ, Black IH. The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism. Crit Care Med 2008;36:S346-57. DOI: https://doi.org/10.1097/CCM.0b013e31817e2fc9
Ho AM, Ho AK, Mizubuti GB, et al. Regional analgesia for patients with traumatic rib fractures: A narrative review. J Trauma Acute Care Surg 2020;88:e22-e30. DOI: https://doi.org/10.1097/TA.0000000000002524
Thiruvenkatarajan V, Cruz Eng H, Adhikary SD. An update on regional analgesia for rib fractures. Curr Opin Anaesthesiol 2018;31:601-7. DOI: https://doi.org/10.1097/ACO.0000000000000637
Southgate SJ, Herbst MK. Ultrasound guided serratus anterior blocks. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
Kunhabdulla NP, Agarwal A, Gaur A, et al. Serratus anterior plane block for multiple rib fractures. Pain Physician 2014;17:E651-3. DOI: https://doi.org/10.36076/ppj.2014/17/E651
Bhalla PI, Solomon S, Zhang R, et al. Comparison of serratus anterior plane block with epidural and paravertebral block in critically ill trauma patients with multiple rib fractures. Trauma Surg Acute Care Open 2021;6:e000621. DOI: https://doi.org/10.1136/tsaco-2020-000621
Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016;41:621-7. DOI: https://doi.org/10.1097/AAP.0000000000000451
Klesius L, Schroeder K. Effective analgesia with bilateral erector spinae plane catheters for a patient with traumatic rib and spine fractures. Case Rep Anesthesiol 2019;2019:9159878. DOI: https://doi.org/10.1155/2019/9159878
Luftig J, Mantuani D, Herring AA, et al. Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block. Am J Emerg Med 2018;36:1391-1396. DOI: https://doi.org/10.1016/j.ajem.2017.12.060
Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. Br J Anaesth 2017;118:474-5. DOI: https://doi.org/10.1093/bja/aex013
Adhikary SD, Liu WM, Fuller E, et al. The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia 2019;74:585-93. DOI: https://doi.org/10.1111/anae.14579
El Malla DA, Helal RAEF, Zidan TAM, El Mourad MB. The effect of erector spinae block versus serratus plane block on pain scores and diaphragmatic excursion in multiple rib fractures. A prospective randomized trial. Pain Med 2022;23:448-55. DOI: https://doi.org/10.1093/pm/pnab214
Terry SM, Shoff KA, Sharrah ML. Improving blunt chest wall injury outcomes: introducing the PIC score. J Trauma Nurs 2021;28:386-94. DOI: https://doi.org/10.1097/JTN.0000000000000618
Bass GA, Stephen C, Forssten MP, et al. Admission triage with pain, inspiratory effort, cough score can predict critical care utilization and length of stay in isolated chest wall injury. J Surg Res 2022;277:310-8. DOI: https://doi.org/10.1016/j.jss.2022.04.001
Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med 2018;36:707-14. DOI: https://doi.org/10.1016/j.ajem.2018.01.008
O'Kelly E, Garry B. Continuous pain relief for multiple fractured ribs. Br J Anaesth 1981;53:989-91. DOI: https://doi.org/10.1093/bja/53.9.989
Fulda GJ, Giberson F, Fagraeus L. A prospective randomized trial of nebulized morphine compared with patient-controlled analgesia morphine in the management of acute thoracic pain. J Trauma 2005;59:383-8. DOI: https://doi.org/10.1097/01.ta.0000179452.70520.1b
Aubrun F, Langeron O, Quesnel C, et al. Relationships between measurement of pain using visual analog score and morphine requirements during postoperative intravenous morphine titration. Anesthesiology 2003;98:1415-21. DOI: https://doi.org/10.1097/00000542-200306000-00017
El-Boghdadly K, Wiles MD. Regional anaesthesia for rib fractures: too many choices, too little evidence. Anaesthesia 2019;74:564-68. DOI: https://doi.org/10.1111/anae.14634
Biswas A, Castanov V, Li Z, et al. Serratus plane block: a cadaveric study to evaluate optimal injectate spread. Reg Anesth Pain Med 2018;43:854-8. DOI: https://doi.org/10.1097/AAP.0000000000000848
Kunigo T, Murouchi T, Yamamoto S, Yamakage M. Spread of injectate inultrasound-guided serratus plane block: a cadaveric study. JA Clin Rep 2018;4:10. DOI: https://doi.org/10.1186/s40981-018-0147-4
Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 2013;68:1107-13. DOI: https://doi.org/10.1111/anae.12344
De la Torre PA, García PD, Alvarez SL, et al. A novel ultrasound-guided block: a promising alternative for breast analgesia. Aesthet Surg J 2014;34:198-200. DOI: https://doi.org/10.1177/1090820X13515902
Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim 2012;59:470-5. DOI: https://doi.org/10.1016/j.redar.2012.07.003
Rose P, Ramlogan R, Sullivan T, Lui A. Serratus anterior plane blocks provide opioid-sparing analgesia in patients with isolated posterior rib fractures: a case series. Can J Anaesth 2019;66:1263-4. DOI: https://doi.org/10.1007/s12630-019-01431-7
Russo E, Latta M, Santonastaso DP, et al. Regional anesthesia in the intensive care unit: a single center’s experience and a narrative literature review. Discov Health Systems 2023;2:4. DOI: https://doi.org/10.1007/s44250-023-00018-w
How to Cite
Serratus plane block and erector spinae plane block in the management of pain associated with rib fractures in chest trauma: a brief report from a single-center. (2025). Advances in Anesthesia and Pain Medicine, 1(1). https://doi.org/10.4081/aapm.11.
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Melissa Nardecchia, Carlo Vallicelli, Mauro Stefano, Vanni Agnoletti, Luca Ansaloni, Paola Fugazzola, Federico Coccolini, Marco Vaira, Massimo Sartelli, Fausto Catena, Current need for guidelines in emergency surgery in peritoneal carcinomatosis , Advances in Anesthesia and Pain Medicine: Vol. 1 No. 1 (2023)
- Domenico Pietro Santonastaso, Pierfrancesco Fusco, Advances in Anesthesia and Pain Medicine: bridging knowledge gaps in pain, anesthesia, and emergency medicine , Advances in Anesthesia and Pain Medicine: Vol. 3 No. 1 (2025)
- Ilaria Piccione, Giovanni D'Agostino, Fabio Marinelli, Dario Cirillo, Antonio Coviello, Gluteal acute compartment syndrome in a patient undergoing neuraxial anesthesia: a case report , Advances in Anesthesia and Pain Medicine: Vol. 3 No. 1 (2025)
- Martina Tocco, Alessandra Venditto, Emmanuel Gasperoni, Elisabetta Rinaldi, Emanuele Russo, Vincenzo Tiberio, interspecies competition and infection control strategies , Advances in Anesthesia and Pain Medicine: Vol. 1 No. 1 (2023)
- Emanuele Russo, Andrea Strada, Vanni Agnoletti, Multidisciplinary teams in high intensity medicine , Advances in Anesthesia and Pain Medicine: Vol. 1 No. 1 (2023)
- Andrea Sica, Daniele Bellantonio, Luca Gobbi, Alessandro Oliva, Alessio Cittadini, The role of Sufentanil in intensive care unit , Advances in Anesthesia and Pain Medicine: Vol. 1 No. 1 (2023)
- Fara Russo, Anna Vitiello, Maria Carolina Russo, Alfonso Riccio, Camillo Candurro, COVID-19 in pregnant women: description of a possible case of COVID-19-linked HELLP-like syndrome , Advances in Anesthesia and Pain Medicine: Vol. 2 No. 1 (2024)
- Fara Russo, Maria Carolina Russo, Camillo Candurro, Stroke in Mycoplasma pneumoniae pneumonia: a clinical case , Advances in Anesthesia and Pain Medicine: Vol. 1 No. 1 (2023)
- Francesco Coletta, Simone Esposito, Giovanna Di Maiolo, Filomena Lo Chiatto, Mariarosaria Cuomo, Giovanna Paola De Marco, Pasqualina Amitrano, Crescenzo Sala, Antonio Tomasello, Romolo Villani, Loxosceles rufescens: single-institutional epidemiology, diagnosis and treatment , Advances in Anesthesia and Pain Medicine: Vol. 2 No. 1 (2024)
Previous
11-19 of 19
You may also start an advanced similarity search for this article.
