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TOPLINE:

Serratus anterior plane block (SAPB) administered in addition to usual care in the emergency department (ED) was safe and linked to improved Pain, Inspiratory Capacity, and Cough (PIC) scores compared with usual care alone in patients with acute rib fractures, a trial found. The benefits lasted 5 hours post-enrollment, supporting the feasibility of SAPB as a bedside ED intervention.

METHODOLOGY:

• In a prospective, open-label randomized controlled trial conducted in the US between 2024 and 2025, 38 adults presenting to the ED with anterior or lateral rib fractures (T2-T9) and pain scores ≥ 5 out of 10 (mean age, 68.9 years; 65.8% men) were included.
• Patients were randomly assigned to receive ultrasound-guided SAPB plus usual care within 2 hours of enrollment (intervention group; n = 19) or usual care alone (control group; n = 19).
• The primary outcome was an improvement in the PIC score, assessed at baseline, 2 hours, and 5 hours post-enrollment.
• The secondary outcome was the total oral morphine equivalent (OME) use at 24 hours after the initial PIC assessment.

TAKEAWAY:

• The intervention group showed greater improvement in PIC scores at 5 hours than the control group (estimated treatment effect, 0.90; P = .03), with a more than 1-point increase achieved by 68.4% and 36.8% of the patients, respectively (P = .04).
• The intervention group showed greater improvement in pain scores at 5 hours than the control group (0.58-point greater improvement; P = .02), with a more than 2-point reduction achieved by 52.6% and 21.1% of the patients, respectively.
• The intervention group had 40% lower OME use over 24 hours than the control group (32.2 mg vs 54.1 mg), although the difference was not statistically significant.

IN PRACTICE:

"Adding the SAPB to usual care produced a statistically significant improvement in PIC scores among ED patients with rib fractures. SAPB was performed safely by emergency physicians and represents a feasible, scalable adjunct for acute rib fracture analgesia in the ED," the authors wrote.

"Larger trials powered for patient-centered clinical outcomes are needed before SAPB can be recommended routinely for rib fracture management in the ED," they added.

SOURCE:

The study was led by Leland Perice, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. It was published online on May 20, 2026, in Academic Emergency Medicine.

LIMITATIONS:

The limitations included the open-label study design, which may have introduced bias in patient-reported outcomes; the single-center setting and small sample size, which may have limited the generalizability of the findings; and the inability to detect rare complications or differences in opioid use and other clinical outcomes because the trial was underpowered. High rates of patient refusal and exclusion may also have affected the findings.

DISCLOSURES:

The study was funded by the Society for Academic Emergency Medicine Foundation and Brown Physicians Inc. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.