Bilateral continuous serratus anterior plane block: An effective alternative for bilateral multiple rib fracture analgesia

Abstract

Pain due to rib fracture leads to respiratory impairment and bilateral fractures impact respiratory mechanics in the worst manner. Thoracic epidural analgesia is the gold standard for bilateral rib fractures but is technically difficult, entails potentially serious complications, and necessitates patient repositioning. Ultrasound-guided serratus anterior plane block (SAPB) has recently gained favor for alleviating thoracic pain and can be performed in patients lying supine, rendering it particularly useful in polytrauma patients who are unable to sit up or turn lateral for regional blocks on the back. Use of continuous bilateral SAPB for rib fractures has been underutilized. We report a case of a polytrauma patient who had bilateral multiple rib fracture along with vertebral and pelvic fractures due to which she was in severe pain and was unable to move to provide any kind of positioning for the blocks. Bilateral SAPB provided effective pain relief and facilitated early recovery and pulmonary rehabilitation of the patient.

Serratus anterior fascia plane block for pain control in patients with multiple rib fractures

“…We provided a detailed explanation regarding the clinical study to five patients who presented to the Emergency department of the Nara Prefecture General Medical Center (Nara, Japan) between October 2022 and December 2022 with multiple rib fractures; among them, three patients provided consent to participate and were included in the study. The inclusion criteria were as follows: (1) patients aged 20-80 years, (2) chest pain due to multiple ribs fracture, (3) no alterations in the level of consciousness, and (4) ability to provide informed consent. The exclusion criteria were as follows: (1) severe infection, (2) pregnancy, (3) ventilator control, (4) severe cognitive impairment (Mini-Mental State Evaluation ≤10), ( 5) inability to answer the questionnaires, or (6) judged to be inappropriate for participation by the principal investigator or co-investigator.…”

“…Epidural and paravertebral blocks are recommended if the analgesia is inadequate; however, pain may prevent proper positioning. Therefore, the serratus anterior fascia plane (SAP) block has attracted attention as a local anesthetic method 2 , 3 ) . Although a previous retrospective study has demonstrated the efficacy of the continue SAP block 4 ) , most patients require SAP blocks to be performed repeatedly.…”