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

Nair, Abhijit; Diwan, Sandeep

doi:10.7759/cureus.21322

Cited by 8 publications

(4 citation statements)

References 48 publications

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“…The authors concluded that there is no difference in efficacy between the SAPB and PVB and epidural anesthesia but noted that the SAPB is a technically easier procedure with more flexibility in patient positioning and fewer contraindications. Nair and Diwan 51 conducted a qualitative review of the literature on the SAPB. In total, 16 articles in total were used in this review concluding that the continuous SAPB was found to be favorable to the single injection method when left in the patient for 3 to 5 days.…”

Section: Other Invasive Analgesic Proceduresmentioning

confidence: 99%

Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians

Rogers

Larson

Rhone

et al. 2023

J Intensive Care Med

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Rib fractures are present in 15% of all traumas and 60% of patients with chest traumas. Rib fractures are not life-threatening in isolation, but they can be quite painful which leads to splinting and compromise of respiratory function. Splinting limits the ability of a patient to take a deep breath, which leads to atelectasis, atelectasis to poor secretion removal, and poor secretion removal leads to pneumonia. Pneumonia is the common pathway to respiratory failure in patients with rib fractures. It is noted that in the elderly, each rib fracture increases developing pneumonia by 27% and the risk of dying by 19%. From a public health perspective, rib fractures have long-term implications with only 59% of patients returning to work at 6 months. In this review we will examine the state of art as it currently exists with regard to the management of pain associated with rib fractures. Included in this overview will be a brief review of the anatomy of the thorax and some important physiologic concepts, the latest trends in pharmacologic and noninvasive means of managing rib pain, a special section on epidural anesthesia, some other alternative invasive methods of pain control, and a review of the recent literature on rib plating. Finally, a practical, easy to follow guideline, to manage the patient with pain from rib fractures will be presented.

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Section: Other Invasive Analgesic Proceduresmentioning

confidence: 99%

Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians

Rogers

Larson

Rhone

et al. 2023

J Intensive Care Med

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show abstract

“…This technique, injecting a certain concentration and volume of non-opioid analgesics into the surface of the anterior serratus muscle or deep interstitial space by a simple operation, confers a more complete and wider nerve block effect and has less complications [ 15 ]. SAPB has shown good performance on postoperative pain management and reducing postoperative opioid consumption in thoracotomy, breast surgery and rib fracture surgery [ 16 – 18 ]. Thus, SAPB appears to be an effective and safe region block that is easy to perform.…”

Section: Introductionmentioning

confidence: 99%

Analgesic effectiveness of serratus anterior plane block in patients undergoing video-assisted thoracoscopic surgery: a systematic review and updated meta-analysis of randomized controlled trials

Liu

Wang

et al. 2023

BMC Anesthesiol

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Background Serratus anterior plane block (SAPB) is a promising regional technique for analgesia in thoracic surgery. Till now, several randomized controlled trials (RCTs) have explored the effectiveness of SAPB for postoperative pain control in patients undergoing video-assisted thoracoscopic surgery (VATS), but the sample sizes were small and conclusions remained in controversy. Therefore, we conducted the present systematic review and meta-analysis. Methods RCTs evaluating the analgesic performance of SAPB, comparing to control methods (no block, placebo or local infiltration anesthesia), in patients undergoing VATS were searched in PubMed, EMBASE, Web of Science and Cochrane Library from inception to December 31, 2022. Mean difference (MD) and corresponding 95% confidence interval (95%CI) were calculated for postoperative pain scores at various time points, postoperative opioid consumption and length of hospital stay. Pooled relative risk (RR) with 95%CI were calculated for the risk of postoperative nausea and vomiting (PONV) and dizziness. A random-effect model was applied. Results A total of 12 RCTs (837 participants) were finally included. Compared to control group, SAPB had significant reductions of postoperative pain scores at 2 h (MD = -1.58, 95%CI: -1.86 to -1.31, P < 0.001), 6 h (MD = -2.06, 95%CI: -2.74 to -1.38, P < 0.001), 12 h (MD = -1.72, 95%CI: -2.30 to -1.14, P < 0.001) and 24 h (MD = -1.03, 95%CI: -1.55 to -0.52, P < 0.001), respectively. Moreover, SAPB conferred a fewer postoperative opioid consumption (MD = -7.3 mg of intravenous morphine equivalent, 95%CI: -10.16 to -4.44, P < 0.001) and lower incidence of PONV (RR = 0.56, 95%CI: 0.41 to 0.77, P < 0.001). There was no difference between both groups regarding length of hospital stay and risk of dizziness. Conclusion SAPB shows an excellent performance in postoperative pain management in patients undergoing VATS by reducing pains scores, postoperative opioid consumption and incidence of PONV. However, due to huge heterogeneity, more well-designed, large-scale RCTs are needed to verify these findings in the future.

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“…[1][2][3][4][5][6] The efficacy of these regional blocks has also been demonstrated in the management of rib fractures. 7,8 A recent systematic review of nerve blocks in plastic surgery has shown favorable outcomes. 9 Of the known truncal regional blocks, PEC 1 and SAP are the least studied, and currently there is no medical evidence which demonstrates their superiority over blind local infiltration anesthesia in plastic surgery.…”

mentioning

confidence: 99%

“…PECs and SAP regional blocks are newer regional anesthetic techniques that have shown efficacy in specialties other than plastic surgery and have become part of routine management for patients undergoing a variety of procedures, including mastectomy, breast lumpectomy, video-assisted thoracic surgery, and others 1–6 . The efficacy of these regional blocks has also been demonstrated in the management of rib fractures 7,8 . A recent systematic review of nerve blocks in plastic surgery has shown favorable outcomes 9 .…”

mentioning

confidence: 99%

Local Infiltration Anesthesia Versus Ultrasound-Guided Pectoralis (PEC1) + Serratus Anterior Plane (SAP) Blocks on Postanesthetic Care Unit Pain Control in Patients Undergoing Primary Submuscular Augmentation Mammoplasty

Heffern,

Puyana,

Hajebian

et al. 2024

Ann Plast Surg

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Background Ultrasound-guided regional field blocks are not widely used in outpatient plastic surgeries. The efficacy of truncal blocks (PEC1 + SAP) has not been established in plastic surgery. The purpose of this study was to analyze the outcomes of these newer anesthetic techniques compared with traditional blind local anesthetic infiltration in patients undergoing breast augmentation. Methods This retrospective institutional review board-approved cohort study compared the outcomes of the different practices of 2 plastic surgeons at the same accredited outpatient surgery center between 2018 and 2022. Group 1 received an intraoperative blind local infiltration anesthetic. Group 2 underwent surgeon-led, intraoperative, ultrasound-guided PEC1 (Pectoralis 1) + SAP (serratus anterior plane) blocks. Patients who underwent any procedure other than primary submuscular augmentation mammoplasty were excluded from the study. The outcomes measured included operative time, opioid utilization in morphine milligram equivalents (MME), pain level at discharge, and time spent in the post anesthetic care unit (PACU). Results Sixty patients met the inclusion criteria for each group for a total of 120 patients. The study groups were similar to each other. Patients receiving PEC1 + SAP blocks (group 2) had significantly lower average MME requirements in the PACU (3.04 MME vs 4.52 MME, P = 0.041) and required a shorter average PACU stay (70.13 minutes vs 80.38 minutes, P = 0.008). There were no significant differences in the pain level at discharge, operative time, or implant size between the 2 groups. Conclusions Surgeon-led, intraoperative, ultrasound-guided PEC1 + SAP blocks significantly decreased opioid utilization in the PACU by 33% and patient time in the PACU by 13%, while achieving similar patient pain scores and operating times.

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

Cited by 8 publications

References 48 publications

Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians

Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians

Analgesic effectiveness of serratus anterior plane block in patients undergoing video-assisted thoracoscopic surgery: a systematic review and updated meta-analysis of randomized controlled trials

Local Infiltration Anesthesia Versus Ultrasound-Guided Pectoralis (PEC1) + Serratus Anterior Plane (SAP) Blocks on Postanesthetic Care Unit Pain Control in Patients Undergoing Primary Submuscular Augmentation Mammoplasty

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