Erector Spinae Plane vs Serratus Anterior Plane Catheter Infusions for Acute Pain Management in Patients With Traumatic Rib Fractures

NCT07756047 | Not Yet Recruiting

• 1 other identifier: 7157
• Study Type: interventional
• Target: 66
• Locations: 1 country
• Sites: 1

Brief Summary

Rib fractures happen in about 10-20% of patients with blunt trauma and can be serious, with higher death rates in older adults. These injuries often lead to lung problems like pneumonia, collapsed lung areas (atelectasis), fluid buildup, or even respiratory failure. A major reason for this is pain-patients avoid deep breathing and coughing, which worsens lung function. Good pain control helps prevent these complications. Opioids are commonly used for pain but can cause problems such as slowed breathing, delirium, nausea, and longer time on a ventilator. Because of this, regional anesthesia (nerve blocks) is increasingly used to control pain while reducing opioid use. Common options include epidurals, paravertebral blocks, and newer techniques like erector spinae plane (ESP) and serratus anterior plane (SAP) blocks. Continuous catheter techniques are especially useful in trauma patients because they can provide ongoing pain relief and have fewer contraindications than epidurals. The SAP block is done at the side of the chest and works well for rib fractures in the front and side. It may not work as well for fractures in the back, although trauma may sometimes allow the anesthetic to spread further than expected. The ESP block is done near the spine and may cover a broader area, including both front and back of the chest. It is relatively easy to perform at the bedside and is considered safe. Studies suggest it provides pain relief similar to epidurals in some patients. There is still limited evidence directly comparing continuous SAP and ESP catheters. Only one study (using single injections) suggests ESP may provide better pain relief. It is unclear whether that difference holds true with continuous infusions, or whether SAP might be preferable because it is easier and quicker to perform. We propose a randomized trial comparing continuous ESP and SAP catheters in patients with rib fractures to determine which provides better pain control, reduces opioid use, improves breathing outcomes, and is easier to perform in routine practice. Our hypotheses are that ESP will provide better pain relief, SAP will be easier and safer to place, and both techniques will reduce opioid use while maintaining good patient comfort and breathing.

Conditions

Traumatic Rib Fracture(s); Traumatic Rib Fracture

Keywords

trauma; rib fracture; regional anesthesia; fascial plane catheter; acute pain

Outcome Measures

Primary Outcomes (1)

• Pain with movement

  Pain Numerical Rating Scale scores with movement from baseline through 72 hours post-placement. Numerical Rating Scale minimum is 0, maximum is 10, higher score = worse pain.

  72 hours

Secondary Outcomes (6)

• Total opioid consumption

  72 hours

• Respiratory function

  72 hours

• Ease of catheter insertion between techniques

  At time of catheter insertion

• Pain at rest

  72 hours

• Procedure related complications

  72 hours

Other Outcomes (6)

• Patient satisfaction

  72 hours

• Catheter-related complications

  72 hours

• Catheter function

  Through hospital admission, an average of 7 days

Study Arms (2)

Erector spinae plane catheter

ACTIVE COMPARATOR

Participants receive erector spinae plane catheter

Procedure: Erector spinae plane catheter

Serratus plane catheter

EXPERIMENTAL

Participants receive serratus anterior plane catheter

Procedure: Serratus plane catheter

Interventions

Erector spinae plane catheter PROCEDURE

Participants receive erector spinae plane catheter infusion

Erector spinae plane catheter

Serratus plane catheter PROCEDURE

Participants receive serratus plane catheter infusion

Serratus plane catheter

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age \>18;
• Traumatic rib fractures (unilateral or bilateral);
• Minimum of 3 rib fractures per side;
• Admitted to hospital for \<72 hours
• NRS pain score \> 4 at rest or with movement for chest pain at the time of eligibility assessment

You may not qualify if:

• Severe traumatic brain injury (Glasgow Coma Scale \< 9);
• Surgery performed/planned within 72 hours of catheter infusion start;
• Uncontrolled coagulopathy;
• Skin infection or anatomical abnormality (i.e. open fracture) at insertion sites;
• Allergy to local anesthetic;
• Chronic high dose opioid use preadmission (Morphine Equivalent Dose \> 30mg per day);
• Pregnancy;
• Acute respiratory failure requiring intubation at enrolment;
• Inability to comply with Intravenous Patient-Controlled Analgesia use;
• Contraindications to nerve blocks
• High likelihood of loss to follow-up

Sponsors & Collaborators

• Sunnybrook Health Sciences Centre: lead

Study Sites (1)

Sunnybrook Health Sciences Centre

Toronto, Ontario, M4N 3M5, Canada

Location

MeSH Terms

Conditions

Wounds and Injuries; Rib Fractures; Acute Pain

Condition Hierarchy (Ancestors)

Fractures, Bone; Thoracic Injuries; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Howard Meng, MD

CONTACT

416-480-4864; howard.meng@sunnybrook.ca

Lilia Kaustov, PhD

CONTACT

416-480-4864; lilia.kaustov@sunnybrook.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 3, 2026
• First Posted: August 10, 2026
• Study Start: August 1, 2026
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): June 30, 2028
• Last Updated: August 10, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)