Serratus Plane Block Is Effective for Pain Control in Patients With Blunt Chest Trauma: A Case Series

Abstract

Background Rib fractures occur frequently following blunt chest trauma and induce morbidity and mortality. Analgesia is a cornerstone for their management, and regional analgesia is one of the tools available to reach this objective. Epidural and paravertebral blocks are the classical techniques used, but the serratus plane block (SPB) has recently been described as an effective technique for thoracic analgesia. Methods This case series reported and analyzed 10 consecutive cases of SPB for blunt chest trauma analgesia in a level 1 trauma center from May to October 2018. SPB was performed with either a single shot of local anesthetic or a catheter infusion. Results Ten patients were treated with 3 single shots and 7 catheter infusions (median length 3 days [interquartile range (IQR) 2.5 to 3.5]). The Median Injury Severity Score was 16 (IQR 16 to 23), and the number of broken ribs ranged from 3 to 22. Daily equivalent oral morphine consumption was significantly decreased after SPB from 108 mg (IQR 67 to 120) to 19 mg (IQR 0 to 58) (P = 0.015). The Numeric Pain Rating Scale (NPRS) score during cough was significantly decreased from 7.3 (IQR 5.3 to 8.8) to 4 (IQR 3.6 to 4.6) (P = 0.03). The NPRS score at rest remained unchanged. One complication occurred, due to a catheter section. Conclusions The SPB technique (with or without catheter insertion) in 10 patients who had blunt chest trauma with rib fractures is effective for cough pain control, with a significant decrease in morphine consumption.

A narrative review of ultrasound-guided serratus anterior plane block

“…Effective and reasonable analgesia can make patients cough and expectorate early, exercise respiratory function, and reduce the incidence of infection and mortality. Martinez et al (25) selected 10 patients with blunt chest trauma and rib fractures. Among the 10 patients, three were treated with SAPB, and the rest were treated with SAPB for shortterm analgesia, followed by continuous infusion of 0.2% ropivacaine at a rate of 0.15 mL/kg/hr.…”

Ultrasound-Guided PECS II + Serratus Plane Fascial Blocks Are Associated with Reduced Opioid Consumption and Lengths of Stay for Minimally Invasive Cardiac Surgery: An Observational Retrospective Study

“…Currently, locoregional anesthesia techniques are very diffused, especially in major surgery such as colorectal and liver surgery, thoracic surgery, orthopedic surgery and kidney transplant surgery. The utility of PECS II and serratus plane block is widely demonstrated in other surgeries such as mastectomy [ 15 ], thoracic surgery [ 16 ], pacemaker implantation [ 17 ], traumatology for ribs fracture [ 18 ] and pediatric surgery [ 19 ], but there are not many studies in cardiac adult surgery. Ultrasound-guided fascial plane blocks have been embraced enthusiastically as an alternative to epidural, paravertebral and perineural injections [ 20 ].…”