{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:18:41Z","timestamp":1788999521902,"version":"build-2803163510"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"\n Importance<\/jats:title>\n Rib fractures secondary to blunt thoracic trauma typically result in severe pain that is notoriously difficult to manage. The serratus anterior plane block (SAPB) is a regional anesthesia technique that provides analgesia to most of the hemithorax; however, SAPB has limited evidence for analgesic benefits in rib fractures.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether the addition of an SAPB to protocolized care bundles increases the likelihood of early favorable analgesic outcomes and reduces opioid requirements in patients with rib fractures.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This multicenter, open-label, pragmatic randomized clinical trial was conducted at 8 emergency departments across metropolitan and regional New South Wales, Australia, between April 12, 2021, and January 22, 2022. Patients aged 16 years or older with clinically suspected or radiologically proven rib fractures were included in the study. Participants were excluded if they were intubated, transferred for urgent surgical intervention, or had a major concomitant nonthoracic injury. Data were analyzed from September 2022 to July 2023.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients were randomly assigned (1:1) to receive an SAPB in addition to usual rib fracture management or standard care alone.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was a composite pain score measured 4 hours after enrollment. Patients met the primary outcome if they had a pain score reduction of 2 or more points and an absolute pain score of less than 4 out of 10 points.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 588 patients were screened, of whom 210 patients (median [IQR] age, 71 [55-84] years; 131 [62%] male) were enrolled, with 105 patients randomized to receive an SAPB plus standard care and 105 patients randomized to standard care alone. In the complete-case intention-to-treat primary outcome analysis, the composite pain score outcome was reached in 38 of 92 patients (41%) in the SAPB group and 18 of 92 patients (19.6%) in the control group (relative risk [RR], 0.73; 95% CI, 0.60-0.89;\n P<\/jats:italic>\n \u2009=\u2009.001). There was a clinically significant reduction in overall opioid consumption in the SAPB group compared with the control group (eg, median [IQR] total opioid requirement at 24 hours: 45 [19-118] vs 91 [34-155] milligram morphine equivalents). Rates of pneumonia (6 patients [10%] vs 7 patients [11%]), length of stay (eg, median [IQR] hospital stay, 4.2 [2.2-7.7] vs 5 [3-7.3] days), and 30-day mortality (1 patient [1%] vs 3 patients [4%]) were similar between the SAPB and control groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This randomized clinical trial found that the addition of an SAPB to standard rib fracture care significantly increased the proportion of patients who experienced a meaningful reduction in their pain score while also reducing in-hospital opioid requirements.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n http:\/\/anzctr.org.au<\/jats:ext-link>\n Identifier:\n ACTRN12621000040864<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2024.0969","type":"journal-article","created":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T11:05:00Z","timestamp":1714561500000},"page":"810","source":"Crossref","is-referenced-by-count":59,"title":["Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management"],"prefix":"10.1001","volume":"159","author":[{"given":"Christopher","family":"Partyka","sequence":"first","affiliation":[{"name":"Emergency Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Aeromedical Operations, NSW Ambulance, Bankstown Aerodrome, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Asha","sequence":"additional","affiliation":[{"name":"Emergency Department, St George Hospital, Sydney, New South Wales, Australia"},{"name":"St George & Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Berry","sequence":"additional","affiliation":[{"name":"Emergency Department, Orange Base Hospital, Orange, New South Wales, Australia"},{"name":"RPA Virtual Hospital, Sydney, New South Wales, Australia"},{"name":"Orange Clinical School, University of Sydney, Orange, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Aeromedical Operations, NSW Ambulance, Bankstown Aerodrome, New South Wales, Australia"},{"name":"Emergency Department, Liverpool Hospital, Liverpool, New South Wales, Australia"},{"name":"South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Burns","sequence":"additional","affiliation":[{"name":"Aeromedical Operations, NSW Ambulance, Bankstown Aerodrome, New South Wales, Australia"},{"name":"Emergency Department, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia"},{"name":"Discipline of Emergency Medicine, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Tsacalos","sequence":"additional","affiliation":[{"name":"Emergency Department, The Sutherland Hospital, Caringbah, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gaetani","sequence":"additional","affiliation":[{"name":"South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Emergency Department, Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia"},{"name":"School of Medicine, University of Western Sydney, Campbelltown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Oliver","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia"},{"name":"Trauma Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia"},{"name":"Greenlight Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina","family":"Luscombe","sequence":"additional","affiliation":[{"name":"School of Rural Health, Sydney Medical School, University of Sydney, Orange, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Delaney","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia"},{"name":"Division of Critical Care, The George Institute of Global Health, University of New South Wales, Sydney, Australia"},{"name":"Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Curtis","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"George Institute for Global Health, Sidney, New South Wales, Australia"},{"name":"Critical Care Research, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"soi240021r1","doi-asserted-by":"publisher","first-page":"76","DOI":"10.13107\/ijra","article-title":"Serratus anterior block for rib fractures: a systematic review and meta-analysis.","volume":"3","author":"Zhen","year":"2022","journal-title":"Int J Reg Anaesth"},{"issue":"1","key":"soi240021r2","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1093\/bjaceaccp\/mkv011","article-title":"Rib fracture management.","volume":"16","author":"May","year":"2016","journal-title":"BJA Educ"},{"issue":"3","key":"soi240021r3","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1097\/01.TA.0000037095.83469.4C","article-title":"Elderly trauma patients with rib fractures are at greater risk of death and pneumonia.","volume":"54","author":"Bergeron","year":"2003","journal-title":"J Trauma"},{"issue":"6","key":"soi240021r4","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1016\/j.injury.2018.03.037","article-title":"Development of a blunt chest injury care bundle: an integrative review.","volume":"49","author":"Kourouche","year":"2018","journal-title":"Injury"},{"issue":"3","key":"soi240021r5","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.aenj.2016.06.002","article-title":"CHIP: an early activation protocol for isolated blunt chest injury improves outcomes, a retrospective cohort study.","volume":"19","author":"Curtis","year":"2016","journal-title":"Australas Emerg Nurs J"},{"issue":"1","key":"soi240021r6","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2016-000064","article-title":"Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol.","volume":"2","author":"Witt","year":"2017","journal-title":"Trauma Surg Acute Care Open"},{"issue":"10","key":"soi240021r7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0256027","article-title":"Impact of a care bundle for patients with blunt chest injury (CHIP): a multicentre controlled implementation evaluation.","volume":"16","author":"Curtis","year":"2021","journal-title":"PLoS One"},{"issue":"3","key":"soi240021r8","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1111\/jgs.2013.61.issue-3","article-title":"Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults.","volume":"61","author":"Rolita","year":"2013","journal-title":"J Am Geriatr Soc"},{"issue":"8","key":"soi240021r9","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1007\/s40266-016-0381-2","article-title":"Constipation in elderly patients with noncancer pain: focus on opioid-induced constipation.","volume":"33","author":"Chokhavatia","year":"2016","journal-title":"Drugs Aging"},{"issue":"11","key":"soi240021r10","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1111\/anae.2013.68.issue-11","article-title":"Serratus plane block: a novel ultrasound-guided thoracic wall nerve block.","volume":"68","author":"Blanco","year":"2013","journal-title":"Anaesthesia"},{"issue":"10","key":"soi240021r11","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1111\/anae.v75.10","article-title":"The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: a qualitative systematic review.","volume":"75","author":"Jack","year":"2020","journal-title":"Anaesthesia"},{"issue":"1","key":"soi240021r12","doi-asserted-by":"publisher","DOI":"10.1186\/s42077-021-00195-x","article-title":"Serratus anterior plane block for cardiothoracic surgeries: a meta-analysis of randomized trials.","volume":"13","author":"Mostafa","year":"2021","journal-title":"Ain-Shams J Anesthesiol"},{"issue":"5","key":"soi240021r13","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1111\/emm.v33.5","article-title":"Regional anaesthesia for rib fractures: A pilot study of serratus anterior plane block.","volume":"33","author":"Schnekenburger","year":"2021","journal-title":"Emerg Med Australas"},{"issue":"5","key":"soi240021r14","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1136\/rapm-2019-101119","article-title":"Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures.","volume":"45","author":"Beard","year":"2020","journal-title":"Reg Anesth Pain Med"},{"issue":"1","key":"soi240021r15","doi-asserted-by":"publisher","first-page":"197.e3","DOI":"10.1016\/j.ajem.2016.07.021","article-title":"Ultrasound-guided serratus plane block for ED rib fracture pain control.","volume":"35","author":"Durant","year":"2017","journal-title":"Am J Emerg Med"},{"key":"soi240021r16","doi-asserted-by":"publisher","first-page":"59","DOI":"10.2147\/LRA","article-title":"Impact of serratus plane block on pain scores and incentive spirometry volumes after chest trauma.","volume":"12","author":"Hernandez","year":"2019","journal-title":"Local Reg Anesth"},{"issue":"3","key":"soi240021r17","doi-asserted-by":"publisher","first-page":"411","DOI":"10.4103\/joacp.JOACP_349_19","article-title":"A retrospective study comparing analgesic efficacy of ultrasound-guided serratus anterior plane block versus intravenous fentanyl infusion in patients with multiple rib fractures.","volume":"37","author":"Diwan","year":"2021","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"4","key":"soi240021r18","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1177\/14604086211046779","article-title":"Efficacy of serratus anterior plane block in pain control in traumatic posterior rib fractures: a case series.","volume":"24","author":"Singh","year":"2021","journal-title":"Trauma"},{"issue":"11","key":"soi240021r19","doi-asserted-by":"publisher","first-page":"2695","DOI":"10.1002\/jum.v41.11","article-title":"Ultrasound-guided serratus anterior plane block (SAPB) improves pain control in patients with rib fractures.","volume":"41","author":"Kring","year":"2022","journal-title":"J Ultrasound Med"},{"issue":"10","key":"soi240021r20","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1007\/s12630-019-01431-7","article-title":"Serratus anterior plane blocks provide opioid-sparing analgesia in patients with isolated posterior rib fractures: a case series.","volume":"66","author":"Rose","year":"2019","journal-title":"Can J Anaesth"},{"key":"soi240021r21","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.ajem.2020.12.041","article-title":"Analgesic efficacy of the serratus anterior plane block in rib fractures pain: a randomized controlled trial.","volume":"41","author":"Teksen","year":"2021","journal-title":"Am J Emerg Med"},{"issue":"4","key":"soi240021r22","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1197\/aemj.10.4.390","article-title":"Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department.","volume":"10","author":"Bijur","year":"2003","journal-title":"Acad Emerg Med"},{"issue":"3","key":"soi240021r23","doi-asserted-by":"publisher","first-page":"151","DOI":"10.4103\/2348-8093.169965","article-title":"Measuring pain in clinical trials: pain scales, endpoints, and challenges.","volume":"2","author":"Bhardwaj","year":"2015","journal-title":"Int J Clin Exp Physiol"},{"issue":"1","key":"soi240021r24","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1046\/j.1442-2026.2001.00179.x","article-title":"Setting the benchmark for research in the management of acute pain in emergency departments.","volume":"13","author":"Kelly","year":"2001","journal-title":"Emerg Med (Fremantle)"},{"issue":"6","key":"soi240021r25","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1111\/emm.v27.6","article-title":"Best-practice pain management in the emergency department: a cluster-randomised, controlled, intervention trial.","volume":"27","author":"Taylor","year":"2015","journal-title":"Emerg Med Australas"},{"issue":"1","key":"soi240021r26","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1159\/000341582","article-title":"Psychometric properties of the Pain Assessment in Advanced Dementia scale compared to self assessment of pain in elderly patients.","volume":"34","author":"Mosele","year":"2012","journal-title":"Dement Geriatr Cogn Disord"},{"issue":"1","key":"soi240021r28","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/s12916-019-1367-9","article-title":"Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method.","volume":"17","author":"Shenkin","year":"2019","journal-title":"BMC Med"},{"issue":"6","key":"soi240021r29","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s40273-018-0642-5","article-title":"A systematic review of studies comparing the measurement properties of the three-level and five-level versions of the EQ-5D.","volume":"36","author":"Buchholz","year":"2018","journal-title":"Pharmacoeconomics"},{"issue":"1","key":"soi240021r30","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1186\/s12874-017-0442-1","article-title":"When and how should multiple imputation be used for handling missing data in randomised clinical trials\u2014a practical guide with flowcharts.","volume":"17","author":"Jakobsen","year":"2017","journal-title":"BMC Med Res Methodol"},{"issue":"4","key":"soi240021r31","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/sim.v30.4","article-title":"Multiple imputation using chained equations: Issues and guidance for practice.","volume":"30","author":"White","year":"2011","journal-title":"Stat Med"},{"issue":"6","key":"soi240021r32","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1007\/s12630-019-01340-9","article-title":"Cadaveric findings of the effect of rib fractures on spread of serratus plane injections.","volume":"66","author":"Johnston","year":"2019","journal-title":"Can J Anaesth"},{"issue":"5-6","key":"soi240021r33","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1111\/jocn.2017.26.issue-5pt6","article-title":"Translating research findings to clinical nursing practice.","volume":"26","author":"Curtis","year":"2017","journal-title":"J Clin Nurs"},{"key":"soi240021r27","unstructured":"eviQ. Opioid Conversion Calculator. Accessed February 2, 2023. https:\/\/www.eviq.org.au\/clinical-resources\/eviq-calculators\/3201-opioid-conversion-calculator"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2818238\/jamasurgery_partyka_2024_oi_240021_1719948184.87084.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T11:07:55Z","timestamp":1720609675000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2818238"}},"subtitle":["The SABRE Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2024,7,1]]},"references-count":33,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2024.0969","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2024,7,1]]}}}