Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Managing Pain Due to Multiple Rib Fractures: A Scoping Review

Abhijit Nair, Sandeep Diwan, Abhijit Nair, Sandeep Diwan

Abstract

Ultrasound (US) guided serratus anterior plane block (SAPB) is a fascial plane block that has been utilized for managing pain after thoracotomy, mastectomy, and fractured ribs. We conducted this qualitative review to investigate the analgesic efficacy of US-guided SAPB in patients who sustained multiple rib fractures (MRFs). We registered our review proposal in a prospective register of systematic reviews, PROSPERO, with identifier CRD42020177145. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the identification, screening, and inclusion of relevant articles. Two authors independently searched Pubmed, Embase, the Cochrane Library, Google Scholar, and Web of Science to identify available randomized controlled trials (RCT), case reports, case series reports where SAPB was used for managing pain due to MRFs. Out of the 66 articles identified by the search strategy, 23 articles were assessed for eligibility, and 16 articles were included in the qualitative review. Due to significant heterogenicity, the presence of only one RCT, the presence of case report or series, availability of only retrospective studies for review, a quantitative analysis using statistical tests were not done. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment was not done as there was only one RCT in the review which had limitations like allocation concealment and blinding. US-guided SAPB is a safe and effective fascial plane block for managing pain in patients who sustain MRFs. Further research in the form of well-designed and adequately powered RCTs is needed to confirm its use in patients with MRFs.

Keywords: acute pain management; multiple rib fractures; nerve block; serratus anterior plane block; ultrasound guided regional anesthesia; ultrasound-guided.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2022, Nair et al.

Figures

Figure 1. Schematic diagram showing needle placement…
Figure 1. Schematic diagram showing needle placement for ultrasound-guided serratus anterior plane block, in superficial and deep plane
Abbreviations: LA - local anesthetic, ICN - intercostal nerve, LCN - lateral cutaneous nerve, Rhom - rhomboids muscle, ESM - erector spinae muscle, Tz - trapezius muscle, SAM - serratus anterior muscle, PECMa - pectoralis major muscle, PECMi - pectoralis minor muscle
Figure 2. Schematic diagram showing needle placement…
Figure 2. Schematic diagram showing needle placement for superficial and deep serratus anterior plane block along with various relevant structures
Abbreviations: R - Rib, LD - latissimus dorsi muscle, E-ICM - external intercostal muscle, I-ICM - internal intercostal muscle, IM-ICM - innermost intercostal muscle, SAM - serratus anterior muscle
Figure 3. PRISMA flow diagram depicting included…
Figure 3. PRISMA flow diagram depicting included and excluded studies

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Source: PubMed

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