{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:35:04Z","timestamp":1792787704181,"version":"4.5.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 158 eligible patients were randomized to receive either ESPB (\n n<\/jats:italic>\n \u202f=\u202f73) or SAPB (\n n<\/jats:italic>\n \u202f=\u202f85), 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\u202fh post-intervention. Secondary outcomes included dynamic pain scores, opioid consumption, respiratory function (diaphragmatic excursion, FVC, FEV1), recovery quality (QoR-15), and clinical outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The ESPB group demonstrated a significantly lower 24-h pain AUC compared to the SAPB group (mean difference \u221217.78, 95% CI: \u221221.00 to \u221214.56,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), indicating superior comprehensive analgesia. ESPB also significantly reduced 24-h opioid consumption and improved QoR-15 scores (both\n p<\/jats:italic>\n \u202f&lt;\u202f0.01). 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 \u22645 fractures (interaction\n p<\/jats:italic>\n \u202f=\u202f0.023). Safety profiles and complication rates were comparable.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Clinical trial registration<\/jats:title>\n Chinese Clinical Trial Registry (ChiCTR), Registration No. ChiCTR2300067544.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1826279","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:37:37Z","timestamp":1780637857000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhiliang","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Emergency, Shaoxing People\u2019s Hospital","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shaoxing People\u2019s Hospital","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1097\/TA.0000000000003828","article-title":"Outcomes of surgical versus nonsurgical treatment for multiple rib fractures: a US hospital matched cohort database analysis","volume":"94","author":"Shiroff","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3519","DOI":"10.1177\/00031348231161713","article-title":"Rib plating outcomes in elderly trauma patients with multiple rib fractures: a community hospital experience","volume":"89","author":"Wasfie","year":"2023","journal-title":"Am Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e91294","DOI":"10.7759\/cureus.91294","article-title":"Innovative techniques and outcomes in pediatric and neonatal thoracic surgery: a comprehensive narrative review of current practices and future directions","volume":"17","author":"Alemam","year":"2025","journal-title":"Cureus"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1097\/ACO.0000000000001273","article-title":"Comparative review of airway anesthesia and sedation methods for awake intubation","volume":"36","author":"Rao","year":"2023","journal-title":"Curr Opin Anesthesiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1111\/anae.15276","article-title":"Ultrasound-guided fascial plane blocks of the chest wall: a state-of-the-art review","volume":"76","author":"Chin","year":"2021","journal-title":"Anaesthesia"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s44158-025-00328-w","article-title":"Thoracic wall fascial plane blocks: a narrative review for breast, thoracic, and cardiac surgery","volume":"6","author":"Dost","year":"2025","journal-title":"J Anesth Analg Crit Care"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1053\/j.jvca.2022.10.026","article-title":"An expert review of Chest Wall fascial plane blocks for cardiac surgery","volume":"37","author":"Hargrave","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"706","DOI":"10.11124\/JBIES-23-00168","article-title":"Effectiveness of erector spinae plane block for rib fracture analgesia: a systematic review protocol","volume":"22","author":"Harford","year":"2024","journal-title":"JBI Evid Synth"},{"key":"ref9","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":"Tek\u015fen","year":"2021","journal-title":"Am J Emerg Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.2147\/JPR.S198350","article-title":"Comparative effectiveness analysis of two regional analgesia techniques for the pain management of isolated multiple rib fractures","volume":"12","author":"Lynch","year":"2019","journal-title":"J Pain Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"598","DOI":"10.3390\/jcm14155598","article-title":"Integrating peripheral nerve blocks in multiple trauma care: current evidence and clinical challenges","volume":"14","author":"Mirea","year":"2025","journal-title":"J Clin Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"111276","DOI":"10.1016\/j.jclinane.2023.111276","article-title":"Pain management for hospitalized patients with rib fractures: a systematic review of randomized clinical trials","volume":"92","author":"Hammal","year":"2024","journal-title":"J Clin Anesth"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"221","DOI":"10.5811\/cpcem.59091","article-title":"Costoclavicular brachial plexus block facilitates painless upper extremity reduction: a case report","volume":"7","author":"Reeves","year":"2023","journal-title":"Clin Pract Cases Emerg Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"104727","DOI":"10.1016\/j.jpain.2024.104727","article-title":"Optimizing diversity, equity and inclusion in pragmatic clinical trials: findings from the pain management Collaboratory","volume":"37","author":"Lovejoy","year":"2025","journal-title":"J Pain"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1016\/j.bja.2022.07.031","article-title":"Clinical effectiveness and safety of spinal anaesthesia compared with general anaesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient-and public-informed outcomes: a systematic review and meta-analysis of randomised controlled trials","volume":"129","author":"Kunutsor","year":"2022","journal-title":"Br J Anaesth"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"156","DOI":"10.4097\/kja.23604","article-title":"Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study","volume":"77","author":"Kele\u015f","year":"2024","journal-title":"Korean J Anesthesiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"434","DOI":"10.17085\/apm.21120","article-title":"Serratus anterior plane block with ultrasound-guided hydrodissection for lateral thoracic pain caused by long thoracic nerve neuropathy\u2014a case report","volume":"17","author":"Kim","year":"2022","journal-title":"Anesth Pain Med (Seoul)"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"106488","DOI":"10.1136\/rapm-2025-106488","article-title":"Single versus two-level superficial parasternal intercostal plane block: cadaveric evaluation of injectate spread with needle tip position on anterior surface of costal cartilage","author":"Christensen","year":"2025","journal-title":"Reg Anesth Pain Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e055070","DOI":"10.1136\/bmjopen-2021-055070","article-title":"Predictors of falls and fractures leading to hospitalisation in 36\u202f101 people with affective disorders: a large representative cohort study","volume":"12","author":"Ma","year":"2022","journal-title":"BMJ Open"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/S0952-8180(01)00346-4","article-title":"Intravenous regional anesthesia with clonidine in the management of complex regional pain syndrome of the knee","volume":"14","author":"Reuben","year":"2002","journal-title":"J Clin Anesth"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1007\/s40272-020-00432-0","article-title":"Clinical and economic evaluation of the impact of midazolam on morphine therapy for pain relief in critically ill ventilated infants with respiratory distress syndrome","volume":"23","author":"Abushanab","year":"2021","journal-title":"Paediatr Drugs"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1990","DOI":"10.1002\/ejp.2020","article-title":"Impact of analgesic techniques on early quality of recovery after prostatectomy: a 3-arm, randomized trial","volume":"26","author":"Beilstein","year":"2022","journal-title":"Eur J Pain"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.injury.2022.07.038","article-title":"Comparison of surgical stabilization of rib fractures vs epidural analgesia on in-hospital outcomes","volume":"54","author":"Martin","year":"2023","journal-title":"Injury"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1053\/j.jvca.2021.05.037","article-title":"Safety of ultrasound-guided serratus anterior and erector spinae fascial plane blocks: a retrospective analysis in patients undergoing cardiac surgery while receiving anticoagulant and antiplatelet drugs","volume":"36","author":"Toscano","year":"2022","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1001\/jamaneurol.2021.2979","article-title":"General anesthesia vs local anesthesia in microelectrode recording-guided deep-brain stimulation for Parkinson disease: the GALAXY randomized clinical trial","volume":"78","author":"Holewijn","year":"2021","journal-title":"JAMA Neurol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"606","DOI":"10.4103\/joacp.joacp_356_24","article-title":"Comparison of two concentrations (0.125 and 0.25%) of bupivacaine for ultrasound guided sacral erector spinae block in paediatric patients undergoing hypospadias repair: a double blind randomised trial","volume":"41","author":"Bansal","year":"2025","journal-title":"J Anaesthesiol Clin Pharmacol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1826279\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:37:41Z","timestamp":1780637861000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1826279\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":26,"alternative-id":["10.3389\/fmed.2026.1826279"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1826279","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]},"article-number":"1826279"}}