The Clinical Impact of Serratus Anterior VS. Erector Spinae Plane Block on Pain Management of Tube Thoracostomy in Emergency Department Patients.

NCT07823920 | Not Yet Recruiting DMC

• 1 other identifier: Tube thoracostomy pain control
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

In the emergency department, tube thoracostomy is a common critical procedure to manage symptomatic pleural issues such as pneumothorax and pleural effusion.\[1\] This technique employed to remove air or fluid from the pleural cavity, restore negative intrapleural pressure and let the lungs expand again to help normal cardiopulmonary function to be restored again. \[2\] However, the procedure is often associated with significant pain, with approximately 50% of patients reporting pain levels between 9-10 out of 10 during the intervention, and for pain management emergency physicians have traditionally combined local anesthetics with opioids or anxiolytics. Yet, these methods have notable drawbacks: opioids carry risks of addiction and adverse side effects (e.g., nausea/vomiting, respiratory depression, delirium), while procedural sedation is time-intensive, requires monitoring, and carries risks of complications such as apnea and hypotension.\[3\] Local anesthetic infiltration for pain management can also fail to effectively and evenly target the intercostal nerves responsible for chest wall sensation.\[4\] Ultrasound-guided fascial plane blocks (erector spinae plane and serratus plane blocks) have recently been proposed as targeted alternatives for reliable and extended pain control of tube thoracostomy as each block produces a unique distribution of anesthesia. \[5\] Despite establishing of these techniques for pain control during thoracic surgeries, its application in emergency settings for tube thoracostomy is underexplored enough yet \[6\], a gap explicitly identified in the recent literature.\[4\] Therefore, in this study we evaluate the impact of ESP and SAP block for pain management and overall quality of recovery which practically performed by emergency physicians.

Conditions

Pain Management; Chest Tube Insertion; Thoracostomy Pain Management

Keywords

tube thoracostomy; pain control; pain managment

Outcome Measures

Primary Outcomes (1)

• Intraprocedural pain score (NRS 0-10) recorded immediately after tube insertion and pleural fixation.

  24 HR

Secondary Outcomes (3)

• Total rescue opioid/sedative dose.

  24 HR

• Time required to perform the block (needle-in to needle-out).

  first 24 HR

• procedure-related complications (pneumothorax, hematoma, local anesthetic systemic toxicity, block failure).

  first 24 HR

Study Arms (2)

SAPB

EXPERIMENTAL

Procedure: serratus anterior plane blocks

ESPB

EXPERIMENTAL

Procedure: Erector Spinae Plane Block

Interventions

serratus anterior plane blocks PROCEDURE

Ultrasound-guided fascial plane block,serratus plane blocks for reliable and extended pain control of tube thoracostomy using 20-30 mL of bupivacaine 0.25%

SAPB

Erector Spinae Plane Block PROCEDURE

Ultrasound-guided fascial plane block,Erector spinae plane block for reliable and extended pain control of tube thoracostomy using 20-30 mL of bupivacaine 0.25%.

ESPB

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Adults aged ≥18 to =\<60 years presenting to the ED requiring tube thoracostomy.
• hemodynamically stable (systolic blood pressure ≥90 mmHg).
• Able to provide informed consent.

You may not qualify if:

• Tension pneumothorax or hemodynamic instability requiring immediate tube insertion without time for block performance.
• Known allergy or hypersensitivity to local anesthetics.
• Infection or cellulitis overlying the intended needle insertion site.
• Chronic opioid use/dependence, or substance use disorder that would confound pain and opioid-consumption outcomes.
• Psychiatric illness, cognitive impairment, intoxication, or severe traumatic brain injury (GCS \< 13) precluding reliable pain-score reporting or informed consent.
• Body mass index ≥ 30 kg/m² (sonoanatomic landmarks less reliable).
• Patients with spinal injury.
• Patinets with fracture rib.

Sponsors & Collaborators

• Assiut University: lead

Study Sites (1)

Assiut University hospital

Asyut, Egypt

Location

Related Publications (5)

• Lopez E, Sahni R, Cooper M, Shalaby M. Serratus Anterior Plane Block for Procedural Anesthesia for Pigtail Tube Thoracostomy: A Case Series. Clin Pract Cases Emerg Med. 2025 Jan;9(1):5-9. doi: 10.5811/cpcem.21251.

  PMID: 39903631 BACKGROUND

• Reeves MT, Lee Y, Shalaby M. Ultrasound-Guided Truncal Blocks for Tube Thoracostomy Analgesia in the Emergency Department. J Emerg Med. 2026 May;84:92-101. doi: 10.1016/j.jemermed.2025.12.026. Epub 2026 Jan 2.

  PMID: 41936304 BACKGROUND

• Rech MA, Griggs C, Lovett S, Motov S. Acute pain management in the Emergency Department: Use of multimodal and non-opioid analgesic treatment strategies. Am J Emerg Med. 2022 Aug;58:57-65. doi: 10.1016/j.ajem.2022.05.022. Epub 2022 May 22.

  PMID: 35636044 BACKGROUND

• Anderson D, Chen SA, Godoy LA, Brown LM, Cooke DT. Comprehensive Review of Chest Tube Management: A Review. JAMA Surg. 2022 Mar 1;157(3):269-274. doi: 10.1001/jamasurg.2021.7050.

  PMID: 35080596 BACKGROUND

• Park BC, Mallemat H. Special Procedures for Pulmonary Disease in the Emergency Department. Emerg Med Clin North Am. 2022 Aug;40(3):583-602. doi: 10.1016/j.emc.2022.05.009.

  PMID: 35953218 BACKGROUND

MeSH Terms

Conditions

Agnosia

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Arwa Salah Arwa

CONTACT

00201156748809; arwasalah.ed@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: arwa salah abdelaziz

Study Record Dates

• First Submitted: September 11, 2026
• First Posted: September 17, 2026
• Study Start (Estimated): June 1, 2027
• Primary Completion (Estimated): December 30, 2029
• Study Completion (Estimated): December 30, 2029
• Last Updated: September 17, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, ANALYTIC CODE

Locations

EG (1)