A retrospective study comparing analgesic efficacy of ultrasound-guided serratus anterior plane block versus intravenous fentanyl infusion in patients with multiple rib fractures

Sandeep Diwan, Abhijit Nair, Sandeep Diwan, Abhijit Nair

Abstract

Background and aims: Inadequately managed pain due to multiple rib fractures (MRFs) can lead to atelectasis, pneumonia, prolonged ICU stay thereby leads to significant morbidity, morbidity and cost of treatment. Opioids, non-steroidal anti-inflammatory drugs and regional anaesthesia techniques like thoracic epidural or paravertebral blocks, intercostal nerve blocks are used to manage pain. Serratus anterior plane block (SAPB) is an ultrasound (US) guided interfascial plane block which has been used in managing pain due to MRFs. In this retrospective study, we compared analgesic efficacy and 24 hr fentanyl consumption in patients with MRFs who were managed with continuous SAPB versus patients who were managed with fentanyl infusion alone.

Material and methods: After Institutional Ethics Committee approval, we retrospectively collected data of 72 patients (38 in SAPB group and 34 in fentanyl group). Demographic data, VAS scores and 24 hrs fentanyl consumption was analysed in both groups.

Results: There were statistically significant lower pain scores in patients of SAPB group when compared to that of fentanyl group (p=0.001) and in 24 hrs fentanyl consumption in patients who received continuous SAPB versus that in fentanyl group(p=0.001). No complications were observed in patients who received US guided SAPB.

Conclusion: US guided SAPB is an opioid sparing, effective interfascial plane block which is safe and should be considered early in all patients who sustain MRFs. Continuous SAPB by placing a catheter can provide pain relief for longer duration, facilitate early mobilization, physiotherapy and early ICU discharge.

Keywords: Fentanyl; fracture; nerve block; pain relief; ribs; serratus anterior; ultrasound.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2021 Journal of Anaesthesiology Clinical Pharmacology.

Figures

Figure 1
Figure 1
Showing USG guided serratus anterior plane block. (Blue arrows- needle, SAM- serratus anterior muscle, R5- fifth rib, pink arrow- pleura)
Figure 2
Figure 2
Shows comparison of VAS score for 1st 24 hrs in both groups. The figure is of a comparative line graph of means + 95% confidence interval in every 6 hrs

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