Prehospital serratus anterior plane block for rib fractures

Fractured ribs are a leading consequence of blunt chest trauma, afflicting approximately 12% of trauma patients (Kring et al, 2022; Singh et al, 2022). Beyond the physical injury, significant pain is associated with rib fractures, posing challenges in relation to adequate ventilation and carrying a significant risk of secondary morbidity. The resultant shallow tidal breathing due to painful rib fractures and the absence of deep inspiration contribute to hypoxemia, atelectasis, and V/Q mismatching, heightening the susceptibility to pneumonia and respiratory failure. When clinicians strive to provide effective pain control for these injuries, they must navigate the delicate balance of minimising pharmacological complications (especially respiratory depression and hypotension from opioids), while optimising respiratory function and pain relief.

The prevailing approach involves multimodal intravenous analgesia with opioids, paracetamol and, possibly, a non-steroidal anti-inflammatory drug (NSAID); however, this approach is not without its drawbacks. Opiate use—though effective in terms of pain relief—introduces undesirable side effects such as respiratory depression, nausea, vomiting, and cough reflex suppression. Consequently, the contemporary focus in trauma care emphasises reducing reliance on opioids in favour of alternative strategies (Fortune and Frawley, 2021; Kay et al, 2022).