Frontiers in medicine · 2026
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.
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Tang Zhiliang, Zhou Lina
Аннотация
OBJECTIVE: This large-sample, randomized, double-blind controlled trial directly compared the analgesic efficacy and impact on respiratory function of ultrasound-guided erector spinae plane block (ESPB) versus serratus anterior plane block (SAPB) in patients with unilateral multiple rib fractures.
METHODS: A total of 158 eligible patients were randomized to receive either ESPB (n = 73) or SAPB (n = 85), performed with 0.375% ropivacaine. The primary outcome was the time-weighted area under the curve (AUC) of resting pain Numerical Rating Scale (NRS) scores over 24 h post-intervention. Secondary outcomes included dynamic pain scores, opioid consumption, respiratory function (diaphragmatic excursion, FVC, FEV1), recovery quality (QoR-15), and clinical outcomes.
RESULTS: The ESPB group demonstrated a significantly lower 24-h pain AUC compared to the SAPB group (mean difference -17.78, 95% CI: -21.00 to -14.56, p < 0.001), indicating superior comprehensive analgesia. ESPB also significantly reduced 24-h opioid consumption and improved QoR-15 scores (both p < 0.01). While both groups showed significant within-group improvement in respiratory function parameters, no significant between-group differences were found. Subgroup analysis revealed that the analgesic superiority of ESPB was consistent across different fracture locations but was more pronounced in patients with ≤5 fractures (interaction p = 0.023). Safety profiles and complication rates were comparable.
CONCLUSION: For patients with unilateral multiple rib fractures, ESPB provides significantly better early comprehensive analgesia and reduces opioid requirements compared to SAPB, without compromising safety. ESPB may be considered as a preferred first-line regional analgesic technique, especially for patients with a lower fracture burden.
CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR), Registration No. ChiCTR2300067544.
METHODS: A total of 158 eligible patients were randomized to receive either ESPB (n = 73) or SAPB (n = 85), performed with 0.375% ropivacaine. The primary outcome was the time-weighted area under the curve (AUC) of resting pain Numerical Rating Scale (NRS) scores over 24 h post-intervention. Secondary outcomes included dynamic pain scores, opioid consumption, respiratory function (diaphragmatic excursion, FVC, FEV1), recovery quality (QoR-15), and clinical outcomes.
RESULTS: The ESPB group demonstrated a significantly lower 24-h pain AUC compared to the SAPB group (mean difference -17.78, 95% CI: -21.00 to -14.56, p < 0.001), indicating superior comprehensive analgesia. ESPB also significantly reduced 24-h opioid consumption and improved QoR-15 scores (both p < 0.01). While both groups showed significant within-group improvement in respiratory function parameters, no significant between-group differences were found. Subgroup analysis revealed that the analgesic superiority of ESPB was consistent across different fracture locations but was more pronounced in patients with ≤5 fractures (interaction p = 0.023). Safety profiles and complication rates were comparable.
CONCLUSION: For patients with unilateral multiple rib fractures, ESPB provides significantly better early comprehensive analgesia and reduces opioid requirements compared to SAPB, without compromising safety. ESPB may be considered as a preferred first-line regional analgesic technique, especially for patients with a lower fracture burden.
CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR), Registration No. ChiCTR2300067544.