{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T04:35:02Z","timestamp":1785558902549,"version":"3.56.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We aimed to investigate whether ultrasound guided erector spinae plane block and serratus anterior plane block would provide effective and safe analgesia in patients with fracture ribs, and to detect their effects on diaphragmatic excursion in such cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Prospective double-blind randomized study<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Settings<\/jats:title>\n                  <jats:p>Tanta University Hospitals<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subject<\/jats:title>\n                  <jats:p>Fifty adult patients ASA I, II with fracture ribs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients were randomized to receive either ultrasound guided erector spinae block (Group I) or serratus plane block (Group II) with injection of 19\u2009ml bupivacaine 0.25% plus 1\u2009ml dexamethasone (4\u2009mg). Pain scores, 24\u2009hour total analgesic requirements, diaphragmatic excursion and incidence of adverse events were recorded.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At rest and dynamic pain scores were significantly lower in Group I as compared to Group II from 2\u2009hour up to 24\u2009hour post block [median differences (95% CI): \u22121 (\u22120.9999; 0.0002), \u22121 (\u22120.9999; 0.0002), \u22121 (\u22120.9998; 0.0003), \u22121(\u22121.000;\u22120.000) and \u22121(\u22122.0000;\u22121.0000), \u22121(\u22120.9998;\u22120.0001), \u22121(\u22121.0001;\u22121.0002), \u22121(\u22122.000; 0.000), respectively], with a significant reduction in 24\u2009hour opioid consumption in Group I in comparison to Group II (P\u2009=\u2009.004*). Diaphragmatic excursion showed a significant improvement in Group I when compared to Group II at 2, 6, 12, and 24\u2009hour after the block (P\u2009=\u2009.024*, .038*, .027*, .042* correspondingly). No adverse events were noted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Both erector spinae block and serratus plane block provided safe and effective pain relief in traumatic rib fractures. Although the erector spinae group displayed significantly reduced pain scores, decreased analgesic needs and improved diaphragmatic excursion as compared to serratus group, nevertheless, this was of no clinical significance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/pm\/pnab214","type":"journal-article","created":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T19:53:45Z","timestamp":1625169225000},"page":"448-455","source":"Crossref","is-referenced-by-count":28,"title":["The Effect of Erector Spinae Block versus Serratus Plane Block on Pain Scores and Diaphragmatic Excursion in Multiple Rib Fractures. A Prospective Randomized Trial"],"prefix":"10.1093","volume":"23","author":[{"given":"Dina Ahmed","family":"El Malla","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehab Abd El fattah","family":"Helal","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer Atef Mohamed","family":"Zidan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona Blough","family":"El Mourad","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"issue":"6","key":"2022030208025878700_pnab214-B1","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/j.amjsurg.2012.05.015","article-title":"Predicting outcome of patients with chest wall injury","volume":"204","author":"Pressley","year":"2012","journal-title":"Am J Surg"},{"issue":"1","key":"2022030208025878700_pnab214-B2","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1093\/bjaceaccp\/mkv011","article-title":"Rib fracture management","volume":"16","author":"May","year":"2016","journal-title":"BJA Educ"},{"issue":"1","key":"2022030208025878700_pnab214-B3","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.injury.2018.10.014","article-title":"The expedited discharge of patients with multiple traumatic rib fractures is cost-effective","volume":"50","author":"Dalton","year":"2019","journal-title":"Injury"},{"issue":"6","key":"2022030208025878700_pnab214-B4","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.amjsurg.2006.08.048","article-title":"A multidisciplinary clinical pathway decreases rib fracture\u2013associated infectious morbidity and mortality in high-risk trauma patients","volume":"192","author":"Todd","year":"2006","journal-title":"Am J Surg"},{"issue":"5","key":"2022030208025878700_pnab214-B5","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/ACO.0000000000000637","article-title":"An update on regional analgesia for rib fractures","volume":"31","author":"Thiruvenkatarajan","year":"2018","journal-title":"Curr Opin Anesthesiol"},{"issue":"4","key":"2022030208025878700_pnab214-B6","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1111\/anae.13830","article-title":"The erector spinae plane block: Plane and simple","volume":"72","author":"El-Boghdadly","year":"2017","journal-title":"Anaesthesia"},{"issue":"5","key":"2022030208025878700_pnab214-B7","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1111\/anae.14579","article-title":"The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: A retrospective cohort study","volume":"74","author":"Adhikary","year":"2019","journal-title":"Anaesthesia"},{"issue":"5","key":"2022030208025878700_pnab214-B8","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1097\/TA.0000000000001209","article-title":"Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society","volume":"81","author":"Galvagno","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"issue":"4","key":"2022030208025878700_pnab214-B9","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s00540-017-2364-9","article-title":"The efficacy of serratus anterior plane block in analgesia for thoracotomy: A retrospective study","volume":"31","author":"\u00d6kmen","year":"2017","journal-title":"J Anesth"},{"issue":"4","key":"2022030208025878700_pnab214-B10","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1097\/TA.0b013e318166d76d","article-title":"Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs\u2014A pilot study","volume":"66","author":"Mohta","year":"2009","journal-title":"J Trauma Acute Care Surg"},{"issue":"8","key":"2022030208025878700_pnab214-B11","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/j.ajem.2017.12.060","article-title":"Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block","volume":"36","author":"Luftig","year":"2018","journal-title":"Am J Emerg Med"},{"key":"2022030208025878700_pnab214-B12","first-page":"132","article-title":"Case report of serratus plane catheter for pain management in a patient with multiple rib fractures and an inferior scapular fracture","volume":"8","author":"Fu","year":"2017","journal-title":"Anesth Analg"},{"issue":"7","key":"2022030208025878700_pnab214-B13","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1053\/j.jvca.2019.02.028","article-title":"Ultrasound-guided serratus plane block versus erector spinae block for postoperative analgesia after video-assisted thoracoscopy: A pilot randomized controlled trial","volume":"33","author":"Gaballah","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2022030208025878700_pnab214-B14","first-page":"1809","article-title":"Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane block perioperatively in radical mastectomy","volume":"99","author":"Wang","year":"2019","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"issue":"5","key":"2022030208025878700_pnab214-B15","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.bja.2020.06.020","article-title":"Comparing erector spinae plane block with serratus anterior plane block for minimally invasive thoracic surgery: A randomised clinical trial","volume":"125","author":"Finnerty","year":"2020","journal-title":"Br J Anaesth"},{"issue":"8","key":"2022030208025878700_pnab214-B16","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1016\/j.ajem.2020.01.007","article-title":"Erector spinae and serratus anterior blocks for the management of rib fractures: A retrospective exploratory matched study","volume":"38","author":"Riley","year":"2020","journal-title":"Am J Emerg Med"},{"issue":"11","key":"2022030208025878700_pnab214-B17","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1111\/anae.12344","article-title":"Serratus plane block: A novel ultrasound-guided thoracic wall nerve block","volume":"68","author":"Blanco","year":"2013","journal-title":"Anaesthesia"},{"issue":"5","key":"2022030208025878700_pnab214-B18","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1097\/AAP.0000000000000451","article-title":"The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain","volume":"41","author":"Forero","year":"2016","journal-title":"Reg Anesth Pain Med"},{"issue":"9","key":"2022030208025878700_pnab214-B19","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1111\/anae.13549","article-title":"Anatomical evaluation of the serratus anterior plane block","volume":"71","author":"Mayes","year":"2016","journal-title":"Anesthesia"},{"key":"2022030208025878700_pnab214-B20","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ijsu.2020.05.038","article-title":"Effects of erector spinae plane block on postoperative pain and side-effects in adult patients underwent surgery: A systematic review and meta-analysis of randomized controlled trials","volume":"80","author":"Cai","year":"2020","journal-title":"Int J Surg"},{"issue":"1","key":"2022030208025878700_pnab214-B21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12871-020-01016-8","article-title":"The effect of ultrasound-guided erector spinae plane block on postsurgical pain: A meta-analysis of randomized controlled trials","volume":"20","author":"Kendall","year":"2020","journal-title":"BMC Anesthesiol"},{"issue":"8","key":"2022030208025878700_pnab214-B22","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1007\/s12630-020-01613-8","article-title":"A magnetic resonance imaging study of local anesthetic spread in patients receiving an erector spinae plane block","volume":"67","author":"Schwartzmann","year":"2020","journal-title":"Can J Anaesth"},{"issue":"6","key":"2022030208025878700_pnab214-B23","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/AAP.0000000000000789","article-title":"A cadaveric study investigating the mechanism of action of erector spinae blockade","volume":"43","author":"Ivanusic","year":"2018","journal-title":"Reg Anesth Pain Med"},{"issue":"1","key":"2022030208025878700_pnab214-B24","doi-asserted-by":"crossref","first-page":"86","DOI":"10.5152\/TJAR.2019.81226","article-title":"Is paravertebral-epidural spread the underlying mechanism of action of erector spinae plane block","volume":"48","author":"Diwan","year":"2020","journal-title":"Turk J Anesthsiol Reanim"},{"key":"2022030208025878700_pnab214-B25","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jclinane.2019.09.011","article-title":"A high thoracic erector spinae plane block used for sympathetic block in patients with upper extremity complex regional pain syndrome","volume":"60","author":"Bang","year":"2020","journal-title":"J Clin Anesth"},{"issue":"1","key":"2022030208025878700_pnab214-B26","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1136\/rapm-2020-101822","article-title":"Daring discourse: Should the ESP block be renamed RIP II block?","volume":"46","author":"Lonnqvist","year":"2021","journal-title":"Reg Anesth Pain Med"},{"issue":"5","key":"2022030208025878700_pnab214-B27","first-page":"480","article-title":"Too deep or not too deep? A propensity-matched comparison of the analgesic effects of a superficial versus deep serratus fascial plane block for ambulatory breast cancer surgery","volume":"43","author":"Abdallah","year":"2018","journal-title":"Reg Anesth Pain Med"},{"issue":"2","key":"2022030208025878700_pnab214-B28","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/AAP.0000000000000555","article-title":"\u201cA tale of two planes\u201d: Deep versus superficial serratus plane block for postmastectomy pain syndrome","volume":"42","author":"Piracha","year":"2017","journal-title":"Reg Anesth Pain Med"},{"issue":"2","key":"2022030208025878700_pnab214-B29","doi-asserted-by":"crossref","first-page":"251","DOI":"10.4103\/joacp.JOACP_294_16","article-title":"Comparison of two different techniques of serratus anterior plane block: A clinical experience","volume":"34","author":"Bhoi","year":"2018","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2022030208025878700_pnab214-B30","first-page":"1","article-title":"Serratus anterior plane block for pain relief in multiple fractured ribs (MFRs): injection of local anesthetic above the serratus or below the serratus anterior muscle-a case report","volume":"1","author":"Jadon","year":"2016","journal-title":"Anesth Med Pract J"},{"issue":"3","key":"2022030208025878700_pnab214-B31","doi-asserted-by":"crossref","first-page":"208","DOI":"10.4103\/JETS.JETS_155_19","article-title":"Ultrasound-guided serratus anterior plane block for rib fracture-associated pain management in emergency department","volume":"13","author":"Paul","year":"2020","journal-title":"J Emerg Trauma Shock"},{"issue":"8","key":"2022030208025878700_pnab214-B32","first-page":"854","article-title":"Serratus plane block: A cadaveric study to evaluate optimal injectate spread","volume":"43","author":"Biswas","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"2022030208025878700_pnab214-B33","doi-asserted-by":"crossref","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":"Tek\u015fen","year":"2021","journal-title":"Am J Emerg Med"},{"issue":"2","key":"2022030208025878700_pnab214-B34","doi-asserted-by":"crossref","first-page":"348","DOI":"10.21608\/ejhm.2021.144900","article-title":"Comparative study between efficacy of serratus anterior muscle block as a regional analgesia technique and IV morphine infusion in patient with fracture ribs","volume":"82","author":"Abu-Elwafa","year":"2021","journal-title":"Egypt J Hosp Med"},{"key":"2022030208025878700_pnab214-B35","first-page":"001","article-title":"Serratus anterior plane block-an analgesic technique for multiple rib fractures: A case series","volume":"3","author":"Jadon","year":"2017","journal-title":"Am J Anesth Clin Res"},{"key":"2022030208025878700_pnab214-B36","doi-asserted-by":"crossref","first-page":"651","DOI":"10.36076\/ppj.2014\/17\/E651","article-title":"Serratus anterior plane block for multiple rib fractures","volume":"17","author":"Kunhabdulla","year":"2014","journal-title":"Pain Physician"},{"issue":"6","key":"2022030208025878700_pnab214-B37","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/AAP.0000000000000649","article-title":"Injection volume and anesthetic effect in serratus plane block","volume":"42","author":"Kunigo","year":"2017","journal-title":"Reg Anesth Pain Med"},{"issue":"4","key":"2022030208025878700_pnab214-B38","doi-asserted-by":"crossref","first-page":"108A","DOI":"10.1016\/j.chest.2019.02.107","article-title":"Serratus anterior plane block for rib fracture pain in the geriatric population","volume":"155","author":"Wong","year":"2019","journal-title":"Chest"},{"issue":"5","key":"2022030208025878700_pnab214-B39","doi-asserted-by":"crossref","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":"3","key":"2022030208025878700_pnab214-B40","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1093\/bja\/aex013","article-title":"Erector spinae plane block for pain relief in rib fractures","volume":"118","author":"Hamilton","year":"2017","journal-title":"Br J Anaesth"},{"issue":"3","key":"2022030208025878700_pnab214-B41","doi-asserted-by":"crossref","first-page":"235","DOI":"10.5152\/TJAR.2018.46794","article-title":"Ultrasound-guided continuous erector spinae plane block in a patient with multiple rib fractures","volume":"47","author":"Kumar","year":"2019","journal-title":"Turk J Anesthsiol Reanim"},{"issue":"6","key":"2022030208025878700_pnab214-B42","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1093\/pm\/pnaa101","article-title":"A randomized trial to compare serratus anterior plane block and erector spinae plane block for pain management following thoracoscopic surgery","volume":"21","author":"Ekinci","year":"2020","journal-title":"Pain Med"},{"issue":"4","key":"2022030208025878700_pnab214-B43","doi-asserted-by":"crossref","first-page":"00589","DOI":"10.1183\/23120541.00589-2020","article-title":"Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients","volume":"6","author":"Shiraishi","year":"2020","journal-title":"ERJ Open Res"},{"issue":"4","key":"2022030208025878700_pnab214-B44","doi-asserted-by":"crossref","first-page":"256","DOI":"10.4103\/ijabmr.IJABMR_192_20","article-title":"Ultrasonographic assessment of diaphragmatic excursion and its correlation with spirometry in chronic obstructive pulmonary disease patients","volume":"10","author":"Qaiser","year":"2020","journal-title":"Int J Appl Basic Med Res"},{"key":"2022030208025878700_pnab214-B45","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jclinane.2017.08.019","article-title":"Paravertebral block restore diaphragmatic motility measured by ultrasonography in patients with multiple rib fractures","volume":"42","author":"Bataille","year":"2017","journal-title":"J Clin Anesth"},{"issue":"10","key":"2022030208025878700_pnab214-B46","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.bjae.2020.06.001","article-title":"Anaesthetic and surgical management of rib fractures","volume":"20","author":"Williams","year":"2020","journal-title":"BJA Educ"},{"issue":"6","key":"2022030208025878700_pnab214-B47","doi-asserted-by":"crossref","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":"8","key":"2022030208025878700_pnab214-B48","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1007\/s12630-019-01383-y","article-title":"Serratus anterior plane block home catheter for posterior rib fractures and flail chest","volume":"66","author":"Rose","year":"2019","journal-title":"Can J Anaesth"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/painmedicine\/advance-article-pdf\/doi\/10.1093\/pm\/pnab214\/39612868\/pnab214.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/23\/3\/448\/42671848\/pnab214.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/23\/3\/448\/42671848\/pnab214.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,2]],"date-time":"2022-03-02T08:05:08Z","timestamp":1646208308000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/23\/3\/448\/6317840"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,8]]},"references-count":48,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,7,8]]},"published-print":{"date-parts":[[2022,3,2]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnab214","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,3,1]]},"published":{"date-parts":[[2021,7,8]]}}}