Impact of serratus plane block on pain scores and incentive spirometry volumes after chest trauma

Nadia Hernandez, Johanna de Haan, Dallis Clendeninn, David E Meyer, Semhar Ghebremichael, Carlos Artime, George Williams, Holger Eltzschig, Sudipta Sen, Nadia Hernandez, Johanna de Haan, Dallis Clendeninn, David E Meyer, Semhar Ghebremichael, Carlos Artime, George Williams, Holger Eltzschig, Sudipta Sen

Abstract

Background: Adequate pain control is difficult to achieve in patients with multiple rib fractures (MRF). Serratus plane block (SPB) is a novel technique for alleviating rib fracture pain. Several published case reports support this hypothesis. Purpose: The purpose of this study was to evaluate the use of SPB in MRF at our level 1 trauma center. Methods: Our hospital's Regional Anesthesia Registry was queried for all trauma patients with MRF who underwent SPB between August 2014 and January 2018. Data were compared in each patient as a matched pair for the time periods before and after undergoing SPB. Thirty-four patients with similar baseline characteristics were enrolled. Results: The median number of rib fractures was 7. Ordinal pain scores were found to be improved 4 hrs after SPB from median 7/10 to 3/10 (P<0.001). Incentive spirometry (IS) volumes recorded 4 and 24 hrs postserratus plane block showed a median increase of 150 and 175 mL from baseline, respectively (P<0.001). IS volumes recorded at 48 hrs showed a median increase of 300 mL from baseline (P<0.001). Respiratory rate decreased from a median value of 24.5 to 16 breaths/min (P<0.001). SpO2 was improved at 24 hrs from median 96% to 99% (P<0.001). Conclusion: SPB improves pain scores and IS volumes in MRF. Because it is not limited by patient positioning or anticoagulation and has a better safety profile, it may offer a viable alternative to neuraxial techniques. Additional studies are necessary to evaluate its efficacy compared to neuraxial techniques.

Keywords: pain management; polytrauma; regional anesthesia; rib fractures.

Conflict of interest statement

Dr Holger Eltzschig reports grants from the United States NIH, and an honorarium from Novartis Pharma AG, outside the submitted work; and reports no other conflicts of interest in this work. The other authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Ultrasound image of the chest wall – the ribs and pleura are identified. Tilting the ultrasound probe allows for visualization of the border between ribs, intercostal, serratus anterior, and latissimus dorsi muscles to allow for proper placement of local anesthetic and/or catheter.
Figure 2
Figure 2
Pain scores–pain scores before and after SPB are depicted by boxplot. Changes in pain score (N=33) were analyzed by the Wilcoxon signed rank test. Bonferroni adjusted correction was applied to control the overall type I error of six comparisons. P-value is <0.001. Abbreviation: SPB, serratus plane block.
Figure 3
Figure 3
IS before and 4 hrs, 24 hrs, 48 hrs after SPB is depicted by boxplot. Changes in IS from baseline (N=28, 25, 21 for 4, 24, and 48 hrs, respectively) were analyzed by the Wilcoxon signed rank test. Bonferroni correction was applied to control the overall type I error of six comparisons. P-values are <0.001 at 4 and 24 hrs. P-value at 48 hrs is 0.001. Abbreviations: IS, incentive spirometry; SPB: serratus plane block.
Figure 4
Figure 4
Respiratory rates before and after SPB are depicted by boxplot. Changes in respiratory rate (N=34) were analyzed by the Wilcoxon signed rank test. Bonferroni correction was applied to control the overall type I error of six comparisons. P-value is <0.001. Abbreviation: SPB, serratus plane block.
Figure 5
Figure 5
SpO2 before and after SBP is depicted by boxplot. Changes in SpO2 (N=34) were analyzed by the Wilcoxon signed rank test. Bonferroni correction was applied to control the overall type I error of six comparisons. P-value is <0.001. Abbreviation: SPB, serratus plane block.

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