Ultrasound-Guided Serratus Anterior Plane Block for Rib Fracture-Associated Pain Management in Emergency Department

Subhankar Paul, Sanjeev Kumar Bhoi, Tej Prakash Sinha, Gaurav Kumar, Subhankar Paul, Sanjeev Kumar Bhoi, Tej Prakash Sinha, Gaurav Kumar

Abstract

Context: Traumatic Rib fractures are common and painful conditions to present in the emergency department. Ultrasound-guided serratus anterior plane block (SAPB) is a newer technique which is being used for managing postthoracotomy, thoracoscopic surgery, or post mastectomy pain by the anesthetists. However, we have recently started utilizing this novel technique in our emergency department for rib fracture patients with severe pain.

Settings and methods: We present a case series of 10 patients of multiple rib fractures (MFRs) with persistent Defense and Veterans Pain Rating Scale 7 or more even after intravenous analgesics where this block was applied by trained emergency physicians (EP).

Results: Following SAPB median (± IQR) pain score reduction was 5 (±4) at 30 min and 7.5 (±2) after 60 min of administering the block. There were no incidences of block failure or block-related complications in our series.

Conclusions: Ultrasound-guided SAPB can be used safely by trained EP in the emergency department to relieve acute severe analgesic-resistant pain in MFR patients.

Keywords: Regional anesthesia; rib fractures; serratus anterior plane block; ultrasound.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Journal of Emergencies, Trauma, and Shock.

Figures

Figure 1
Figure 1
Ergonomics of the serratus anterior plane block
Figure 2
Figure 2
Probe position at the right mid-axillary line over 5th Rib
Figure 3
Figure 3
Normal sonoanatomy of serratus anterior plane block. LD: Latissimus Dorsi Muscle, SA: Serratus Anterior Muscle, white arrow showing 5th Rib, yellow arrow showing pleural line
Figure 4
Figure 4
Ultrasound-guided needle tracking and hydrodissection by local anesthetic. LD: Latissimus dorsi muscle, SA: Serratus anterior muscle, White arrow showing needle tip with flow of local anesthetics

References

    1. Southgate SJ, Herbst MK. StatPearls. Treasure Island, FL: StatPearls Publishing; 2019. [[Last updated on 2019 Mar 19]]. Ultrasound guided serratus anterior blocks.
    1. Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54:478–85.
    1. Ho AM, Karmakar MK, Critchley LA. Acute pain management of patients with multiple fractured ribs: A focus on regional techniques. Curr Opin Crit Care. 2011;17:323–7.
    1. May L, Hillermann C, Patil S. Rib fracture management. Bja Educ. 2015;16:26–32.
    1. Khemka R, Chakraborty A. Ultrasound-guided modified serratus anterior plane block for perioperative analgesia in breast oncoplastic surgery: A case series. Indian J Anaesth. 2019;63:231–4.
    1. Madabushi R, Tewari S, Gautam SK, Agarwal A, Agarwal A. Serratus anterior plane block: A new analgesic technique for post-thoracotomy pain. Pain Physician. 2015;18:E421–4.
    1. Buckenmaier CC, 3rd, Galloway KT, Polomano RC, McDuffie M, Kwon N, Gallagher RM. Preliminary validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a military population. Pain Med. 2013;14:110–23.
    1. Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: A novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68:1107–13.
    1. Mayes J, Davison E, Panahi P, Patten D, Eljelani F, Womack J, et al. An anatomical evaluation of the serratus anterior plane block. Anaesthesia. 2016;71:1064–9.
    1. Khalil AE, Abdallah NM, Bashandy GM, Kaddah TA. Ultrasound-guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain. J Cardiothorac Vasc Anesth. 2017;31:152–8.
    1. Park MH, Kim JA, Ahn HJ, Yang MK, Son HJ, Seong BG. A randomised trial of serratus anterior plane block for analgesia after thoracoscopic surgery. Anaesthesia. 2018;73:1260–4.
    1. Zocca JA, Chen GH, Puttanniah VG, Hung JC, Gulati A. Ultrasound-guided serratus plane block for treatment of postmastectomy pain syndromes in breast cancer patients: A case series. Pain Pract. 2017;17:141–6.
    1. Pérez Herrero MA, López Álvarez S, Fadrique Fuentes A, Manzano Lorefice F, Bartolomé Bartolomé C, González de Zárate J. Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block. Rev Esp Anestesiol Reanim. 2016;63:564–71.
    1. Piracha MM, Thorp SL, Puttanniah V, Gulati A. “A tale of two planes”: Deep versus superficial serratus plane block for postmastectomy pain syndrome. Reg Anesth Pain Med. 2017;42:259–62.
    1. Kunhabdulla NP, Agarwal A, Gaur A, Gautam SK, Gupta R, Agarwal A. Serratus anterior plane block for multiple rib fractures. Pain Physician. 2014;17:E553–5.
    1. Durant E, Dixon B, Luftig J, Mantuani D, Herring A. Ultrasound-guided serratus plane block for ED rib fracture pain control. Am J Emerg Med. 2017;35:197e3.
    1. Jadon A, Jain P, Sinha N, Agrawal A. Serratus anterior plane block for pain relief in multiple fractured ribs (MFRs); injection of local anesthetic above the serratus or below the serratus anterior muscle – A case report. Anesth Med Pract J. 2016:G103.
    1. Camacho FC, Segura-Grau E. Continuous serratus anterior plane block provides analgesia in multiple rib fractures: A case report. Rev Bras Anestesiol. 2019;69:87–90.
    1. Bossolasco M, Bernardi E, Fenoglio LM. Continuous serratus plane block in a patient with multiple rib fractures. J Clin Anesth. 2017;38:85–6.
    1. Jadon A, Jain P. Serratus anterior plane block-an analgesic technique for multiple rib fractures: A case series. SRL Anesth. 2017;3:001–4.
    1. Bhoi D, Selvam V, Yadav P, Talawar P. Comparison of two different techniques of serratus anterior plane block: A clinical experience. J Anaesthesiol Clin Pharmacol. 2018;34:251–3.
    1. Ökmen K. Comparison of efficiency of serratus anterior plane block and thoracic epidural block for thoracotomy analgesia. Arch Clin Exp Med. 2018;3:156–9.
    1. Wang H, Liu Y, Ge W, Bian L, Pu L, Jiang Y, et al. Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane block perioperatively in radical mastectomy. Zhonghua Yi Xue Za Zhi. 2019;99:1809–13.
    1. Jain P, Jadon A, Motaka M. Serratus anterior plane block failed to relieve pain in multiple fractured ribs: Report of two cases. J Recent Adv Pain. 2017;3:50–3.
    1. Johnston DF, Black ND, O'Halloran R, Turbitt LR, Taylor SJ. Cadaveric findings of the effect of rib fractures on spread of serratus plane injections. Can J Anaesth. 2019;66:738–9.
    1. Rose P, Ramlogan R, Madden S, Lui A. Serratus anterior plane block home catheter for posterior rib fractures and flail chest. Can J Anaesth. 2019;66:997–8.

Source: PubMed

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