Erector Spinae Plane vs Serratus Anterior Plane Catheter Infusions for Acute Pain Management in Patients With Traumatic Rib Fractures (NCT07756047)
🩺 Plain-English Summary (8th-Grade Level)
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.
Who can join: To join this study, participants generally need to meet the listed inclusion criteria (5 items) and avoid the listed exclusions (12 items).
Location: Sunnybrook Health Sciences Centre — Toronto, Ontario
📋 "Do I Qualify?" — 1-Minute Self Screener
Instant ChecklistCheck every box below. If you can check all of them, you may meet the study's basic screening requirements (final eligibility is confirmed by the site team).
Usually NOT eligible if any of the following apply:
- Exclusion Criteria:
- 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
🔍 Extracted verbatim from the official NIH eligibility criteria. Always confirm with the study coordinator.
📍 All Participating Trial Locations (1 Sites)
- Sunnybrook Health Sciences Centre — Toronto, Ontario
💰 Cost, Insurance & Patient Rights
- 100% Free Items: The investigational treatment and protocol-required procedures are supplied at zero cost by the sponsor.
- Routine Patient Care: Under federal law (ACA § 2709) and many state statutes, routine care costs are covered during participation.
- Voluntary Participation: You may withdraw at any time without affecting your standard medical care.