The Clinical Impact of Serratus Anterior VS. Erector Spinae Plane Block on Pain Management of Tube Thoracostomy in Emergency Department Patients.
September 11, 2026 updated by: Arwa Salah Abdelaziz Ali, Assiut University
In the emergency department, tube thoracostomy is a common critical procedure to manage symptomatic pleural issues such as pneumothorax and pleural effusion.[1]
This technique employed to remove air or fluid from the pleural cavity, restore negative intrapleural pressure and let the lungs expand again to help normal cardiopulmonary function to be restored again.
[2] However, the procedure is often associated with significant pain, with approximately 50% of patients reporting pain levels between 9-10 out of 10 during the intervention, and for pain management emergency physicians have traditionally combined local anesthetics with opioids or anxiolytics.
Yet, these methods have notable drawbacks: opioids carry risks of addiction and adverse side effects (e.g., nausea/vomiting, respiratory depression, delirium), while procedural sedation is time-intensive, requires monitoring, and carries risks of complications such as apnea and hypotension.[3]
Local anesthetic infiltration for pain management can also fail to effectively and evenly target the intercostal nerves responsible for chest wall sensation.[4]
Ultrasound-guided fascial plane blocks (erector spinae plane and serratus plane blocks) have recently been proposed as targeted alternatives for reliable and extended pain control of tube thoracostomy as each block produces a unique distribution of anesthesia.
[5] Despite establishing of these techniques for pain control during thoracic surgeries, its application in emergency settings for tube thoracostomy is underexplored enough yet [6], a gap explicitly identified in the recent literature.[4]
Therefore, in this study we evaluate the impact of ESP and SAP block for pain management and overall quality of recovery which practically performed by emergency physicians.
Study Overview
Status
Not yet recruiting
Intervention / Treatment
Study Type
Interventional
Enrollment (Estimated)
80
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Arwa Salah Arwa
- Phone Number: 00201156748809
- Email: arwasalah.ed@gmail.com
Study Locations
-
-
-
Asyut, Egypt
- Assiut university hospital
-
Contact:
- Assuit university hospital
- Phone Number: 00201156748809
- Email: arwaabdelaziz.54@gmail.com
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Adults aged ≥18 to =<60 years presenting to the ED requiring tube thoracostomy.
- hemodynamically stable (systolic blood pressure ≥90 mmHg).
- Able to provide informed consent.
Exclusion Criteria:
- Tension pneumothorax or hemodynamic instability requiring immediate tube insertion without time for block performance.
- Known allergy or hypersensitivity to local anesthetics.
- Infection or cellulitis overlying the intended needle insertion site.
- Chronic opioid use/dependence, or substance use disorder that would confound pain and opioid-consumption outcomes.
- Psychiatric illness, cognitive impairment, intoxication, or severe traumatic brain injury (GCS < 13) precluding reliable pain-score reporting or informed consent.
- Body mass index ≥ 30 kg/m² (sonoanatomic landmarks less reliable).
- Patients with spinal injury.
- Patinets with fracture rib.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: ESPB
|
Ultrasound-guided fascial plane block,Erector spinae plane block for reliable and extended pain control of tube thoracostomy using 20-30 mL of bupivacaine 0.25%.
|
|
Experimental: SAPB
|
Ultrasound-guided fascial plane block,serratus plane blocks for reliable and extended pain control of tube thoracostomy using 20-30 mL of bupivacaine 0.25%
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Intraprocedural pain score (NRS 0-10) recorded immediately after tube insertion and pleural fixation.
Time Frame: 24 HR
|
24 HR
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Total rescue opioid/sedative dose.
Time Frame: 24 HR
|
24 HR
|
|
Time required to perform the block (needle-in to needle-out).
Time Frame: first 24 HR
|
first 24 HR
|
|
procedure-related complications (pneumothorax, hematoma, local anesthetic systemic toxicity, block failure).
Time Frame: first 24 HR
|
first 24 HR
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Anderson D, Chen SA, Godoy LA, Brown LM, Cooke DT. Comprehensive Review of Chest Tube Management: A Review. JAMA Surg. 2022 Mar 1;157(3):269-274. doi: 10.1001/jamasurg.2021.7050.
- Lopez E, Sahni R, Cooper M, Shalaby M. Serratus Anterior Plane Block for Procedural Anesthesia for Pigtail Tube Thoracostomy: A Case Series. Clin Pract Cases Emerg Med. 2025 Jan;9(1):5-9. doi: 10.5811/cpcem.21251.
- Reeves MT, Lee Y, Shalaby M. Ultrasound-Guided Truncal Blocks for Tube Thoracostomy Analgesia in the Emergency Department. J Emerg Med. 2026 May;84:92-101. doi: 10.1016/j.jemermed.2025.12.026. Epub 2026 Jan 2.
- Rech MA, Griggs C, Lovett S, Motov S. Acute pain management in the Emergency Department: Use of multimodal and non-opioid analgesic treatment strategies. Am J Emerg Med. 2022 Aug;58:57-65. doi: 10.1016/j.ajem.2022.05.022. Epub 2022 May 22.
- Park BC, Mallemat H. Special Procedures for Pulmonary Disease in the Emergency Department. Emerg Med Clin North Am. 2022 Aug;40(3):583-602. doi: 10.1016/j.emc.2022.05.009.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Estimated)
June 1, 2027
Primary Completion (Estimated)
December 30, 2029
Study Completion (Estimated)
December 30, 2029
Study Registration Dates
First Submitted
September 11, 2026
First Submitted That Met QC Criteria
September 11, 2026
First Posted (Actual)
September 17, 2026
Study Record Updates
Last Update Posted (Actual)
September 17, 2026
Last Update Submitted That Met QC Criteria
September 11, 2026
Last Verified
September 1, 2026
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Tube thoracostomy pain control
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
all collected IPD
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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