Morbidity and mortality after serratus anterior plane block for unilateral anterolateral rib fractures

Assessment of Morbidity and Mortality Following Serratus Anterior Plane Block (SAPB) for Unilateral Rib Fractures

This study tests whether giving a serratus anterior plane block (SAPB) within 24 hours to adults with multiple unilateral anterolateral rib fractures can reduce complications like pneumonia, shorten hospital stay, improve discharge outcomes, and lower death compared with usual opioid-based pain control.

Quick facts

• Study type: Observational
• Enrollment: 220 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Albert Einstein College of Medicine (other)
• Locations: 1 site (The Bronx, New York)
• Trial ID: NCT07032766 on ClinicalTrials.gov

What this trial studies

Researchers will observe adults who present to the Jacobi Medical Center emergency department within 24 hours of injury with two or more unilateral anterior or lateral rib fractures. If a clinician trained in SAPB is available, the patient may receive an ultrasound-guided serratus anterior plane block; if not, the patient will receive standard systemic analgesia, typically opioids. Patients will be followed through hospital discharge and up to 60 days to record outcomes including pneumonia, length of stay, discharge disposition, and mortality. The study compares real-world outcomes between patients who receive SAPB and those who receive usual analgesic regimens.

Who should consider this trial

Good fit: Adults aged 18 or older who present within 24 hours to the Jacobi ED with two or more unilateral anterior or lateral rib fractures, are expected to require hospital admission, and can consent (or have a health care proxy) are the intended participants.

Not a fit: Patients with bilateral or posterior rib fractures, those who are hemodynamically unstable or in traumatic arrest, pregnant patients, those expected to be discharged within 24 hours, people unable to consent, or those with significant distracting injuries or known anesthetic allergy are unlikely to be eligible or to benefit from SAPB in this protocol.

Why it matters

Potential benefit: If successful, SAPB could reduce respiratory complications and mortality, shorten hospital stays, and decrease opioid exposure for patients with multiple unilateral rib fractures.

How similar studies have performed: Small observational studies and case series of fascial plane blocks, including SAPB, have shown improved pain control and reduced opioid use, but robust evidence that SAPB reduces pneumonia, length of stay, or mortality is limited.

Eligibility criteria

Inclusion Criteria:

* Patients over 18 years of age being treated in the Emergency Department at Jacobi Medical Center
* Presenting within 24 hours of injury
* Patient with 2 or more unilateral, anterior or lateral rib fractures
* Able to provide consent (patient or health care proxy)
* Clinical team believes the patient will require inpatient admission at the time of enrollment

Exclusion Criteria:

* Patients in traumatic arrest or hemodynamic instability
* Patient expected to be discharged from the hospital within 24 hours
* Prisoner
* Pregnancy
* Children less than 18 years of age
* The patient is known or is suspected to be allergic to anesthetic
* Significant pain from another traumatic and distracting injury
* Patients without the ability to consent (or no health care proxy to consent)
* Patients with bilateral or posterior rib fractures

Where this trial is running

The Bronx, New York

• Jacobi Medical Center — The Bronx, New York, United States (RECRUITING)

Study contacts

• Principal investigator: Michelle Montenegro, MD — Albert Einstein College of Medicine, Jacobi medical center
• Study coordinator: Ariella Gartenberg, MD

Conditions: Pain Management, Rib Fracture Multiple, Serratus Anterior Plane Block, serratus anterior plane block, rib fractures, mortality, morbidity