Ultrasound-guided erector spinae plane block versus serratus anterior plane block for analgesia and respiratory function in patients with multiple rib fractures: a large-sample, single-center, randomized, double-blind, controlled trial.
这项大样本、随机、双盲对照试验直接比较了超声引导下竖脊肌平面阻滞（ESPB）与前锯肌平面阻滞（SAPB）在单侧多发肋骨骨折患者中的镇痛疗效及对呼吸功能的影响。共158例符合条件的患者被随机分配接受ESPB（n=73）或SAPB（n=85），均使用0.375%罗哌卡因。主要结局为干预后24小时内静息疼痛数字评分量表（NRS）评分的時間加权曲线下面积（AUC）。次要结局包括动态疼痛评分、阿片类药物消耗量、呼吸功能（膈肌移动度、FVC、FEV1）、恢复质量（QoR-15）及临床结局。ESPB组24小时疼痛AUC显著低于SAPB组（平均差-17.78，95% CI：-21.00至-14.56，P<0.001），表明其综合镇痛效果更优。ESPB还显著减少了24小时阿片类药物消耗量并改善了QoR-15评分（均P<0.01）。虽然两组呼吸功能参数在组内均有显著改善，但组间无显著差异。亚组分析显示，ESPB的镇痛优势在不同骨折部位间保持一致，但在骨折数≤5的患者中更为明显（交互作用P=0.023）。安全性特征和并发症发生率相当。对于单侧多发肋骨骨折患者，与SAPB相比，ESPB可提供显著更好的早期综合镇痛并减少阿片类药物需求，且不损害安全性。ESPB可考虑作为首选的一线区域镇痛技术，尤其适用于骨折负担较低的患者。中国临床试验注册中心（ChiCTR），注册号ChiCTR2300067544。
This large-sample, randomized, double-blind controlled trial directly compared the analgesic efficacy and impact on respiratory function of ultrasound-guided erector spinae plane block (ESPB) versus serratus anterior plane block (SAPB) in patients with unilateral multiple rib fractures. A total of 158 eligible patients were randomized to receive either ESPB ( = 73) or SAPB ( = 85), performed with 0.375% ropivacaine. The primary outcome was the time-weighted area under the curve (AUC) of resting pain Numerical Rating Scale (NRS) scores over 24 h post-intervention. Secondary outcomes included dynamic pain scores, opioid consumption, respiratory function (diaphragmatic excursion, FVC, FEV1), recovery quality (QoR-15), and clinical outcomes. The ESPB group demonstrated a significantly lower 24-h pain AUC compared to the SAPB group (mean difference -17.78, 95% CI: -21.00 to -14.56, < 0.001), indicating superior comprehensive analgesia. ESPB also significantly reduced 24-h opioid consumption and improved QoR-15 scores (both < 0.01). While both groups showed significant within-group improvement in respiratory function parameters, no significant between-group differences were found. Subgroup analysis revealed that the analgesic superiority of ESPB was consistent across different fracture locations but was more pronounced in patients with ≤5 fractures (interaction = 0.023). Safety profiles and complication rates were comparable. For patients with unilateral multiple rib fractures, ESPB provides significantly better early comprehensive analgesia and reduces opioid requirements compared to SAPB, without compromising safety. ESPB may be considered as a preferred first-line regional analgesic technique, especially for patients with a lower fracture burden. Chinese Clinical Trial Registry (ChiCTR), Registration No. ChiCTR2300067544.
Zhiliang Tang, Lina Zhou. Ultrasound-guided erector spinae plane block versus serratus anterior plane block for analgesia and respiratory function in patients with multiple rib fractures: a large-sample, single-center, randomized, double-blind, controlled trial.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1826279.
Zhiliang Tang, Lina Zhou (2026). Ultrasound-guided erector spinae plane block versus serratus anterior plane block for analgesia and respiratory function in patients with multiple rib fractures: a large-sample, single-center, randomized, double-blind, controlled trial.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1826279
Zhiliang Tang, Lina Zhou. Ultrasound-guided erector spinae plane block versus serratus anterior plane block for analgesia and respiratory function in patients with multiple rib fractures: a large-sample, single-center, randomized, double-blind, controlled trial.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1826279.
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