Serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures: a prospective cohort study
Background Rib fractures are common injuries associated with considerable morbidity, long-term disability, and mortality. Early, adequate analgesia is important to mitigate complications such as pneumonia and respiratory failure. Regional anesthesia has been proposed for rib fracture pain control du...
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BMJ Publishing Group
2024-04-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001183.full |
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| author | Jeff Choi David Spain James V Quinn Youyou Duanmu Victor Sadauskas Mariame Fofana Dalton Brunson |
| author_facet | Jeff Choi David Spain James V Quinn Youyou Duanmu Victor Sadauskas Mariame Fofana Dalton Brunson |
| author_sort | Jeff Choi |
| collection | DOAJ |
| description | Background Rib fractures are common injuries associated with considerable morbidity, long-term disability, and mortality. Early, adequate analgesia is important to mitigate complications such as pneumonia and respiratory failure. Regional anesthesia has been proposed for rib fracture pain control due to its superior side effect profile compared with systemic analgesia. Our objective was to evaluate the effect of emergency physician-performed, ultrasound-guided serratus anterior plane block (SAPB) on pain and respiratory function in emergency department patients with multiple acute rib fractures.Methods This was a prospective observational cohort study of adult patients at a level 1 trauma center who had two or more acute unilateral rib fractures. Eligible patients received a SAPB if an emergency physician trained in the procedure was available at the time of diagnosis. Primary outcomes were the absolute change in pain scores and percent change in expected incentive spirometry volumes from baseline to 3 hours after rib fracture diagnosis.Results 38 patients met eligibility criteria, 15 received the SAPB and 23 did not. The SAPB group had a greater decrease in pain scores at 3 hours (−3.7 vs. −0.9; p=0.003) compared with the non-SAPB group. The SAPB group also had an 11% (CI 1.5% to 17%) increase in percent expected spirometry volumes at 3 hours which was significantly better than the non-SAPB group, which had a −3% (CI −9.1% to 2.7%) decrease (p=0.008).Conclusion Patients with rib fractures who received SAPB as part of a multimodal pain control strategy had a greater improvement in pain and respiratory function compared with those who did not. Larger trials are indicated to assess the generalizability of these initial findings. |
| format | Article |
| id | doaj-art-0ee3d624208c4140b1402a2dacae52b4 |
| institution | DOAJ |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-0ee3d624208c4140b1402a2dacae52b42025-08-20T03:11:33ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-04-019110.1136/tsaco-2023-001183Serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures: a prospective cohort studyJeff Choi0David Spain1James V Quinn2Youyou Duanmu3Victor Sadauskas4Mariame Fofana5Dalton Brunson6General Surgery, Stanford University, Stanford, California, USADepartment of Surgery, Stanford University, Stanford, California, USADepartment of Emergency Medicine, Stanford University, Stanford, California, USADepartment of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USADepartment of Emergency Medicine, Vituity, Emeryville, California, USADepartment of Emergency Medicine, Stanford University, Stanford, California, USAStanford University, Stanford, California, USABackground Rib fractures are common injuries associated with considerable morbidity, long-term disability, and mortality. Early, adequate analgesia is important to mitigate complications such as pneumonia and respiratory failure. Regional anesthesia has been proposed for rib fracture pain control due to its superior side effect profile compared with systemic analgesia. Our objective was to evaluate the effect of emergency physician-performed, ultrasound-guided serratus anterior plane block (SAPB) on pain and respiratory function in emergency department patients with multiple acute rib fractures.Methods This was a prospective observational cohort study of adult patients at a level 1 trauma center who had two or more acute unilateral rib fractures. Eligible patients received a SAPB if an emergency physician trained in the procedure was available at the time of diagnosis. Primary outcomes were the absolute change in pain scores and percent change in expected incentive spirometry volumes from baseline to 3 hours after rib fracture diagnosis.Results 38 patients met eligibility criteria, 15 received the SAPB and 23 did not. The SAPB group had a greater decrease in pain scores at 3 hours (−3.7 vs. −0.9; p=0.003) compared with the non-SAPB group. The SAPB group also had an 11% (CI 1.5% to 17%) increase in percent expected spirometry volumes at 3 hours which was significantly better than the non-SAPB group, which had a −3% (CI −9.1% to 2.7%) decrease (p=0.008).Conclusion Patients with rib fractures who received SAPB as part of a multimodal pain control strategy had a greater improvement in pain and respiratory function compared with those who did not. Larger trials are indicated to assess the generalizability of these initial findings.https://tsaco.bmj.com/content/9/1/e001183.full |
| spellingShingle | Jeff Choi David Spain James V Quinn Youyou Duanmu Victor Sadauskas Mariame Fofana Dalton Brunson Serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures: a prospective cohort study Trauma Surgery & Acute Care Open |
| title | Serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures: a prospective cohort study |
| title_full | Serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures: a prospective cohort study |
| title_fullStr | Serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures: a prospective cohort study |
| title_full_unstemmed | Serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures: a prospective cohort study |
| title_short | Serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures: a prospective cohort study |
| title_sort | serratus anterior plane block improves pain and incentive spirometry volumes in trauma patients with multiple rib fractures a prospective cohort study |
| url | https://tsaco.bmj.com/content/9/1/e001183.full |
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