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Not yet recruitingNCT07823920Updated Sep 17, 2026

The Clinical Impact of Serratus Anterior VS. Erector Spinae Plane Block on Pain Management of Tube Thoracostomy in Emergency Department Patients.

An interventional study of serratus anterior plane blocks and Erector Spinae Plane Block in Thoracostomy Pain Management, Pain Management and Chest Tube Insertion, sponsored by Assiut University. Not yet recruiting at 1 site in Egypt. Open to participants aged 18 Years to 60 Years. Per ClinicalTrials.gov, last updated 2026-09-17.

Sponsored by Assiut University · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
80
Allocation
Randomized
Ages
18 Years to 60 Years
Sex
All
01

Study summary

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.

02

Conditions studied

  • Thoracostomy Pain Management
  • Pain Management
  • Chest Tube Insertion

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Keywords

  • tube thoracostomy
  • pain control
  • pain managment
03

Who can participate

Ages eligible
18 Years to 60 Years
Sexes eligible
All
Accepts healthy volunteers
No

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

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.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Participant)
Enrollment
80 participants (estimated)

Study arms

  • Experimental
    SAPB

    Procedure: serratus anterior plane blocks

  • Experimental
    ESPB

    Procedure: Erector Spinae Plane Block

Interventions

  • Procedureserratus anterior plane blocks

    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%

  • ProcedureErector Spinae Plane Block

    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%.

05

What researchers measure

Primary outcomes

  1. Intraprocedural pain score (NRS 0-10) recorded immediately after tube insertion and pleural fixation.

    Time frame: 24 HR

Secondary outcomes

  1. Total rescue opioid/sedative dose.

    Time frame: 24 HR

  2. Time required to perform the block (needle-in to needle-out).

    Time frame: first 24 HR

  3. procedure-related complications (pneumothorax, hematoma, local anesthetic systemic toxicity, block failure).

    Time frame: first 24 HR

06

Study locations

1 site
07

References and documents

Publications

  • 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. PubMed 39903631 ↗
  • 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. PubMed 41936304 ↗
  • 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. PubMed 35636044 ↗
  • 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. PubMed 35080596 ↗
  • 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. PubMed 35953218 ↗

Individual participant data

Plan to share: Yes — all collected IPD

Supporting information: Study protocol, Sap, Icf, Analytic code

08

Registry details

Key details

Study ID
NCT07823920
Lead sponsor
Assiut University
Responsible party
Arwa Salah Abdelaziz Ali (arwa salah abdelaziz, Assiut University) — Principal investigator
First posted
Sep 17, 2026
Start date
Jun 1, 2027 (estimated)
Primary completion
Dec 30, 2029 (estimated)
Completion
Dec 30, 2029 (estimated)
Last update
Sep 17, 2026

Study contacts

Arwa Salah Arwa
Contact
arwasalah.ed@gmail.com
00201156748809

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is not yet recruiting, as verified in Sep 2026. You cannot join it, but the record below documents what was studied.

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