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

Study Overview
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Brief Summary
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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
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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.

Official Title
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The Effect of the Serratus Anterior Plane Block in Improving Pain and Respiratory Function in Trauma Patients Presenting to the Emergency Department With Multiple Rib Fractures.

Conditions
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Rib Fracture Multiple

Intervention / Treatment
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* Other: Serratus Anterior Plane Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age greater or equal to 18 years of age Presentation to Stanford University Hospital Emergency Department within 12 hours of a traumatic incident Three or more anterior and/or lateral unilateral rib fractures diagnosed by CT GCS 15, with the ability to discern and describe pain from rib fractures and give consent Presentation to the Emergency Department between 7am and 11pm (for identification by research assistants) Exclusion Criteria: Posterior rib fractures Bilateral rib fractures Sternal fracture Known allergy to local anesthetics Pregnancy Significant coagulopathy Hemodynamic instability

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Serratus anterior plane block and traditional analgesia<br>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 | Other: Serratus Anterior Plane Block<br>* Injection of bupivacaine 75mg above the serratus anterior facial plane in the anterior axillary line<br>|
| Traditional analgesia<br>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 | |

What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Analgesia administration | Dosage of analgesic medications administered for pain during ED visit and hospital stay | Up to 3 days |