Ultrasound Guided Serratus Anterior Plane Block for Rib Fractures

This study is a single center, randomized controlled trial examining the effect of serratus anterior plane block (SAPB) on pain, PIC scores and other clinical outcomes in emergency department patients with multiple rib fractures in comparison to the use of analgesic medication alone.ObjectivesCompare SAPB performed in the ED setting to analgesic medication alone with regard to pain, respiratory status and PIC score of patients with multiple rib fractures.Assess the safety and feasibility of performing ultrasound-guided SAPB in the ED.Evaluate outcomes of patients receiving the SAPB in the ED including amount of analgesic medications used, level of care required, need for upgrading level of care, and length of stay.

Inclusion Criteria:Age >18 years>1 Unilateral, acute rib fractures diagnosed on x-ray or CT imagingPatient presenting to the WellSpan York Hospital EDPatient requiring IV analgesia or oral opioid to control pain related to rib fracturesExclusion Criteria:Age <18 yearsInability to provide informed consentAllergy to local anesthesiaSubsequent visit for rib fracturesPatients taken emergently to the OR or discharged from the EDSignificant distracting injuries/polytrauma that would not be expected to be responsive to analgesia from SAPB and confound pain scores, i.e. long bone fractures, intraabdominal injuries, etc.