Ultrasound-guided erector spinae plane block versus serratus anterior plane block for analgesia and respiratory function in patients with multiple rib fractures: a large-sample, single-center, randomized, double-blind, controlled trial.

Study Summary

158 patients with acute unilateral multiple rib fractures were randomized to receive ultrasound-guided erector spinae plane block (ESPB) or serratus anterior plane block (SAPB), both using 0.375% ropivacaine. The primary outcome of interest was the time-weighted area under the curve (AUC) of resting Numerical Rating Scale (NRS) pain scores over 24 hours. Secondary outcomes included cough-evoked pain, opioid consumption, diaphragmatic excursion, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), Quality of Recovery-15 (QoR-15), hospital length of stay, pulmonary complications, and adverse events. Outcomes were assessed through 24 hours, with clinical outcomes monitored during hospitalization. Overall, the results revealed that ESPB significantly reduced the 24-hour resting pain burden, opioid requirements, and improved QoR-15 scores compared with SAPB, while improvements in respiratory function were similar between groups. These findings suggest that ESPB may provide superior early analgesia without compromising respiratory recovery or safety.