Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain

Serkan Tulgar, Bahadır Ciftci, Ali Ahiskalioglu, Bora Bilal, Bayram U Sakul, Ali O Korkmaz, Nureda N Bozkurt, Alessandro De Cassai, Augusto J Torres, Hesham Elsharkawy, Haci A Alici, Serkan Tulgar, Bahadır Ciftci, Ali Ahiskalioglu, Bora Bilal, Bayram U Sakul, Ali O Korkmaz, Nureda N Bozkurt, Alessandro De Cassai, Augusto J Torres, Hesham Elsharkawy, Haci A Alici

Abstract

Background and objective We report a novel block technique aimed to provide thoracic analgesia: the serratus posterior superior intercostal plane (SPSIP) block. Design A cadaveric evaluation along with a retrospective case series evaluating the potential analgesic effect of the SPSIP block. This study included one unembalmed cadaver and five patients. Interventions Bilateral ultrasound-guided SPSIP block was used on cadavers with 30 mL of methylene blue 0.5% on each side; single-injection SPSIP blocks were used in patients. To measure results, dye spread was used in the cadaver, and dermatomal/pain score evaluation was used in patients. Main results Anatomical investigation in one unembalmed cadaver shows that its mechanism of action covers the rhomboid major muscle, erector spinae muscle, the deep fascia of the subscapularis/serratus anterior muscles, and intercostal nerves. In our patients, SPSIP resulted in an almost complete sensory block in the back of the neck, shoulder, and hemithorax. Conclusion Our cadaveric study shows extensive dye spread from C7 to T7. Patients who were administrated SPSIP block reported consistent dermatomal blockade from C3 to T10 levels of the hemitorax. The SPSIP block seems to be a safe, simple, and effective technique for thoracic analgesia.

Keywords: cadaveric study; interfascial plane block; pain management; serratus posterior superior intercostal plane block; thoracic analgesia.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2023, Tulgar et al.

Figures

Figure 1. Descriptive features of SPSIP
Figure 1. Descriptive features of SPSIP
Figure 1A: Patient, probe, and needle position during SPSIP; Figure 1B: Sonoanatomy and spread of LA during SPSIP. White arrows indicate needle; Figure 1C and D: Schematic illustration at the level of the third rib demonstrating needle/probe position and injectate spread during SPSIP. SPSIP - serratus posterior superior intercostal plane, Tm - trapezius muscle, RMm - rhomboid major muscle, SPSm - serratus posterior superior muscle, LA - local anesthetic, ESM - erector spinae muscle
Figure 2. Cadaveric dissection of SPSIP
Figure 2. Cadaveric dissection of SPSIP
Figure 2A: Dye spread is seen around Tm and RMm, Figure 2B, 2C: Dye spread is seen around SPSm under the scapula. LCBI is indicated with yellow arrows; Figure 2D, 2E: Dye spread is seen around ICm under RMm. Yellow arrows indicate ICm. Tm - trapezius muscle, RMm - rhomboid major muscle, SPSm - serratus posterior superior muscle, LCBI - lateral cutaneous branches of intercostal nerves, ICm - intercostal muscle
Figure 3. Dermatomal coverage of SPSIP
Figure 3. Dermatomal coverage of SPSIP
A, B, and C demonstrate sensorial blockage in patient five (max coverage) SPSIP - serratus posterior superior intercostal plane

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