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Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures
  1. Laura Beard1,
  2. Carl Hillermann2,
  3. Emma Beard3,
  4. Sue Millerchip2,
  5. Rajneesh Sachdeva1,
  6. Fang Gao Smith4 and
  7. Tonny Veenith1,4
  1. 1Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Birmingham, UK
  2. 2Department of Anaesthesia, University Hospitals Coventry and Warwickshire, Coventry, UK
  3. 3Research Department of Behavioural Science and Health, UCL, University College London, London, UK
  4. 4Birmingham Acute Care Research Group, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Laura Beard, Anaesthetics, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK; laura-beard{at}


Background There 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).

Methods 354 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 results Across 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.

Conclusion SAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.

  • acute pain
  • truncal blocks
  • regional anesthesia

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  • Twitter @carl_hillermann, @veenith_tonny

  • Contributors All those designated as authors meet the criteria for authorship as defined by the ICMJE recommendations.

  • Funding EB is funded by Cancer Research UK. FGS is supported by the National Institute for Health Research (NIHR) Senior Investigator Award. TV is supported by NIHR, CRN Research Scholar and Queen Elizabeth hospital charities.

  • Competing interests C Hillermann, L Beard, S Millerchip have had conference travel fees funded by Pajunk. E Beard has received unrestricted research funding from Pfizer for the Smoking Toolkit study ( outside of the period of this study. E Beard has no conflicts of interest to declare for this study.

  • Patient consent for publication Not required.

  • Ethics approval Institutional approval was obtained from both sites (GF0223/CARMS14833)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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