Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

Research output: Contribution to journalArticlepeer-review


  • Laura Beard
  • Carl Hillermann
  • Emma Beard
  • Sue Millerchip
  • Rajneesh Sachdeva

External organisations

  • Queen Elizabeth Hospital Birmingham, Queen Elizabeth Medical Centre
  • Warwickshire, Solihull and Coventry Breast Screening Service, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom.
  • NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London WC1E 6DD, UK.
  • Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
  • Department of Anaesthesia and Critical Care


BACKGROUND: There is a paucity of data comparing effectiveness of various techniques for pain management of traumatic rib fractures. This study compared the quality of analgesia provided by serratus anterior plane (SAP) catheters against thoracic epidural (TEA) or paravertebral catheters (PA) in patients with multiple traumatic rib fractures (MRFs).

METHODS: 354 patients who received either SAP, TEA or PA at two tertiary referral major trauma centers in the UK were included (2016-2018). Primary outcome were change in inspiratory volumes and pain scores. Secondary outcomes included in-hospital mortality, along with the length of stay in hospital and critical care. Data were analyzed using linear, log-binomial and negative binomial regression models.

MAIN RESULTS: Across all blocks, there was a mean (SD) increase in inspiratory volume postblock of 789.4 mL (479.7). Ninety-eight per cent of all participants reported moderate/severe pain prior to regional analgesia, which was reduced to 34% postblock. There was no significant difference in the change in inspiratory volume or pain scores between the TEA, PA or SAP groups. Overall crude mortality was 13.2% (95% CI 7.8% to 18.7%). In an adjusted analysis and compared with TEA, in-hospital mortality was similar between groups (relative risk (RR) 0.4, 95% CI 0.1 to 1.0) and (RR 0.5, 95% CI 0.2 to 1.6) for SAP and PA, respectively.

CONCLUSION: SAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.

Bibliographic note

© American Society of Regional Anesthesia & Pain Medicine 2020. Re-use permitted under CC BY. Published by BMJ.


Original languageEnglish
Pages (from-to)351-356
Number of pages6
JournalRegional Anesthesia and Pain Medicine
Issue number5
Publication statusPublished - May 2020