Serratus Anterior Plane Blocks: Effectiveness in the management of pain associated with multiple traumatic rib fractures.

Beard, Laura (2025). Serratus Anterior Plane Blocks: Effectiveness in the management of pain associated with multiple traumatic rib fractures. University of Birmingham. M.D.

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Abstract

Background
Patients with multiple rib fractures are at significant risk of respiratory complications such as pneumonia if their pain is not controlled. Regional analgesia with thoracic epidural is seen as the optimal method, but its use is limited to between 3% and 18.4% of patients. Opioids despite causing respiratory depression and sedation still dominate [1-5].

Serratus anterior plane blocks (SAP) with their ease of insertion, haemodynamic stability and perceived safety, are increasing in popularity; however, conclusive evidence for their use in rib fractures is lacking[6]. This research aims to understand better the role of SAP analgesia in patients with traumatic rib fractures.

Objectives
(i) Improve understanding of the mechanisms by which SAP blocks produce
analgesia in patients with rib fractures.
(ii) Assess the clinical effectiveness and safety of SAP analgesia.
(iii) Evaluate the impact of SAP analgesia on patient outcomes.

Methods
To answer these questions, the thesis is split into:-
a) A systematic review of existing literature,
b) A cadaveric study
c) Propensity matched retrospective studies comparing SAP analgesia to thoracic epidural, paravertebral catheters, and opioid medication.

Results
A review of the literature and the findings of the studies presented in this thesis support the opinion that SAP analgesia is a safe technique that improves analgesia and respiratory mechanics in patients with multiple rib fractures.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):