scholarly journals Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

2020 ◽  
Vol 45 (5) ◽  
pp. 351-356 ◽  
Author(s):  
Laura Beard ◽  
Carl Hillermann ◽  
Emma Beard ◽  
Sue Millerchip ◽  
Rajneesh Sachdeva ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Negative Binomial ◽  
Rib Fractures ◽  
Serratus Anterior ◽  
Regional Analgesia ◽  
Cross Sectional ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Significant Difference ◽  
Anterior Plane

BackgroundThere is a paucity of data comparing effectiveness of various techniques for pain management of traumatic rib fractures. This study compared the quality of analgesia provided by serratus anterior plane (SAP) catheters against thoracic epidural (TEA) or paravertebral catheters (PA) in patients with multiple traumatic rib fractures (MRFs).Methods354 patients who received either SAP, TEA or PA at two tertiary referral major trauma centers in the UK were included (2016–2018). Primary outcome were change in inspiratory volumes and pain scores. Secondary outcomes included in-hospital mortality, along with the length of stay in hospital and critical care. Data were analyzed using linear, log-binomial and negative binomial regression models.Main resultsAcross all blocks, there was a mean (SD) increase in inspiratory volume postblock of 789.4 mL (479.7). Ninety-eight per cent of all participants reported moderate/severe pain prior to regional analgesia, which was reduced to 34% postblock. There was no significant difference in the change in inspiratory volume or pain scores between the TEA, PA or SAP groups. Overall crude mortality was 13.2% (95% CI 7.8% to 18.7%). In an adjusted analysis and compared with TEA, in-hospital mortality was similar between groups (relative risk (RR) 0.4, 95% CI 0.1 to 1.0) and (RR 0.5, 95% CI 0.2 to 1.6) for SAP and PA, respectively.ConclusionSAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.

scholarly journals Comparison of serratus anterior plane block with epidural and paravertebral block in critically ill trauma patients with multiple rib fractures

2021 ◽  
Vol 6 (1) ◽  
pp. e000621
Author(s):  
Paul I Bhalla ◽  
Stuart Solomon ◽  
Ray Zhang ◽  
Cordelie E Witt ◽  
Arman Dagal ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Critically Ill ◽  
Outcome Measures ◽  
Rib Fractures ◽  
Serratus Anterior ◽  
Multiple Rib Fractures ◽  
Neuraxial Block ◽  
Pain Scores ◽  
Anterior Plane

BackgroundPain from rib fractures is associated with significant pulmonary morbidity. Epidural and paravertebral blocks (EPVBs) have been recommended as part of a multimodal approach to rib fracture pain, but their utility is often challenging in the trauma intensive care unit (ICU). The serratus anterior plane block (SAPB) has potential as an alternative approach for chest wall analgesia.MethodsThis retrospective study compared critically injured adults sustaining multiple rib fractures who had SAPB (n=14) to EPVB (n=25). Patients were matched by age, body mass index, American Society of Anesthesiology Physical Status, whether the patient required intubation, number of rib fractures and injury severity score. Outcome measures included hospital length of stay, ICU length of stay, preblock and post block rapid shallow breathing index (RSBI) in intubated patients, pain scores and morphine equivalent doses administered 24-hour preblock and post-block in non-intubated patients, and mortality.ResultsThere were no demographic differences between the two groups after matching. Nearly all of the patients who received either SAPB or EPVB demonstrated a reduction in RSBI or pain scores. The preblock RSBI was higher in the serratus anterior plane block group, but there was no difference between any of the other outcome measures.DiscussionThis retrospective study of our institutional data suggests no difference in efficacy between the serratus anterior plane block and neuraxial block for traumatic rib fracture pain in critically ill patients, but the sample size was too small to show statistical equivalence. Serratus anterior plane block is technically easier to perform with fewer theoretical contraindications compared with traditional neuraxial block. Further study with prospective comparative trials is warranted.Level of evidenceRetrospective matched cohort; Level IV.

scholarly journals Serratus Anterior Plane Block for Multiple Rib Fractures

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. E651-E662
Author(s):  
Nishad Poolayullathil Kunhabdulla
Keyword(s):  
Rib Fractures ◽  
Serratus Anterior ◽  
Multiple Rib Fractures ◽  
Anterior Plane

scholarly journals Serratus Anterior Plane Block for Multiple Rib Fractures

2014 ◽  
Vol 4;17 (4;7) ◽  
pp. E553-E555 ◽  
Author(s):  
Nishad Poolayullathil K Kunhabdulla
Keyword(s):  
Rib Fractures ◽  
Serratus Anterior ◽  
Multiple Rib Fractures ◽  
Anterior Plane

Treatment With Oral Versus Intravenous Acetaminophen in Elderly Trauma Patients With Rib Fractures: A Prospective Randomized Trial

2020 ◽  
Vol 86 (8) ◽  
pp. 926-932
Author(s):  
Andrew C. Antill ◽  
Sarah W. Frye ◽  
James C. McMillen ◽  
James C. Haynes ◽  
Benjamin R. Ford ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Pain Score ◽  
Study Groups ◽  
Oral Solution ◽  
Rib Fractures ◽  
Trauma Patients ◽  
Opioid Use ◽  
Increased Risk ◽  
Significant Difference ◽  
Elderly Trauma Patients

Background Rib fractures are common injuries among traumatically injured patients, and elderly patients with rib fractures are at increased risk for adverse events and death. The purpose of this study was to determine if oral Per os (PO) acetaminophen is as effective as intravenous (IV) acetaminophen in treating the pain associated with rib fractures. Methods We performed a single-center, randomized, placebo-controlled, double-blinded study. Trauma patients who were ≥65 years old and had ≥1 rib fracture were included in this study. Patients were randomized into IV acetaminophen and oral placebo (n = 63) or IV placebo and oral solution acetaminophen (n = 75) groups. The primary outcome was a mean reduction in pain score at 24 hours, and secondary outcomes included opioid use, intensive care unit (ICU) length of stay (LOS), hospital LOS, hospital mortality, the difference in incentive spirometry, and development of pneumonia. Results Among the 138 patients included, there was no statistically significant difference between the 2 study groups in a mean reduction in pain score at 24 hours after injury (PO: 3.24, IV: 2.49; P = .230). Opioid pain medication use was equivalent between groups ( P = .212), and there was no significant difference in hospital mortality rate between groups ( P = .827). There was no statistically significant difference in ICU LOS, hospital LOS, or development of pneumonia. Discussion In elderly trauma patients (age ≥65 years) with 1 or more rib fractures, PO acetaminophen is equivalent to IV acetaminophen for pain control, with no difference in morbidity or mortality. Oral acetaminophen should be preferentially used over IV acetaminophen when treating the elderly trauma patient with rib fractures.

The Use of Paravertebral Analgesia in the Management of Pain in the Elderly Patient With Rib Fractures

2020 ◽  
pp. 000313482093355
Author(s):  
Tarik Wasfie ◽  
Adam Howell ◽  
N Cwalina ◽  
Raquel Yapchai ◽  
Jennifer Hille ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Rib Fractures ◽  
Morbidity Rate ◽  
Control Group ◽  
High Morbidity ◽  
Pain Scores ◽  
High Morbidity Rate ◽  
Significant Difference ◽  
The Mean

Background Elderly patients with rib fractures carry a high morbidity rate, particularly due to pulmonary complications as decreased respiratory efforts ensue secondary to pain. Risk of bleeds in the elderly on anticoagulant therapy is high. The effort to reduce narcotic use in patients is now a health care priority. We propose that the use of paravertebral analgesia (PVA) pumps is an alternative pain control method with less risk and easy placement. Methods Two hundred and seventy-nine patients were admitted with multiple fractured ribs to the Trauma Center of Community Hospital and treated with the application of continuous PVA via a pump (72 patients). Pain scores were recorded before and after the initiation of the pump. These patients were compared with a group of the remaining 207 patients who received intravenous narcotics only. Results The mean change from baseline in pain scores for all patients was 1.43 (SD = 2.75). The mean change in pain for the treatment group was 1.93 (SD = 2.60), and the change in pain for the control group was 1.24 (SD = 2.79). Change in pain differed between groups (1.3 vs 1.8; P = .01) although it was a small difference. After adjusting for age, gender, Injury Severity Score, Glasgow Coma Scale, number of fractures, and comorbid conditions, there was no significant difference in pain post-procedure (odds ratio = 0.75; P = 0.39) with an effect size of 30% and total sample size of 279. Conclusion The PVA pump using bupivacaine is an effective safe and alternative method for managing elderly patients with rib fractures eliminating the serious side effects associated with narcotics.

scholarly journals A Randomized Trial to Compare Serratus Anterior Plane Block and Erector Spinae Plane Block for Pain Management Following Thoracoscopic Surgery

Pain Medicine ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 1248-1254
Author(s):  
Mürsel Ekinci ◽  
Bahadir Ciftci ◽  
Birzat Emre Gölboyu ◽  
Yavuz Demiraran ◽  
Yusuf Bayrak ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Thoracoscopic Surgery ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Serratus Anterior ◽  
Erector Spinae Plane Block ◽  
Significant Difference ◽  
Vas Scores ◽  
Anterior Plane ◽  
Effective Analgesia

Abstract Objective Comparison of ultrasound (US)-guided erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in video-assisted thoracic surgery (VATS) patients. The primary outcome was to compare perioperative and postoperative (48 hours) opioid consumption. Methods A total of 60 patients were randomized into two groups (N = 30): an ESPB group and an SAPB group. All the patients received intravenous patient-controlled postoperative analgesia and ibuprofen 400 mg intravenously every eight hours. Visual analog scale (VAS) scores, opioid consumption, and adverse events were recorded. Results Intraoperative and postoperative opioid consumption at 0–8, 8–16, and 16–24 hours and rescue analgesic use were significantly lower in the ESPB group (P < 0.05). Static/dynamic VAS scores were significantly lower in the ESPB group (P < 0.05). There was no significant difference between static VAS scores at the fourth hour. There were no differences between adverse effects. Block procedure time and one-time puncture success were similar between groups (P  > 0.05 each). Conclusion US-guided ESPB may provide better pain control than SAPB after VATS. Question Even though there are studies about analgesia management after VATS, clinicians want to perform the technique that is both less invasive and more effective. Findings This randomized trial showed that US-guided ESPB provides effective analgesia compared with SAPB. Meaning Performing single-injection ESPB reduces VAS scores and opioid consumption compared with SAPB.

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