Abstract
Background & Objectives: A new ultrasound guided regional anaesthetic technique, the serratus plane block (SPB) (1) is performed in the midaxillary line upon the 5th rib, where local anaesthetic (LA) is injected from superior-anterior to posterior-inferior in the fascial plane between the external intercostal and serratus muscle or upon the serratus muscle; covering in both cases the anterior lateral branches (ALB) of the intercostal nerves (ICN). The serratus-intercostal fascial plane block (SIFB or BRILMA) (2) is placing the LA in the same serratus-intercostal fascial plane but with a different needle and injection orientation from caudad to cephalad. While an easy to perform and safe technique in adults, it has not been described in children. Port-A-Cath (PAC) placement upon the 2nd-4th ribs, or extraction, is a common procedure in children, often painful postoperatively. Since the sensitive innervation of the this area is provided by the lateral anterior branch of 2nd-4th IC nerves, the aim of this preliminary study was to evaluate the suitability of a modified SPB in children undergoing a PAC placement or extraction surgery. Materials & Methods: We included 8 children (4-10y, 16-33kg) undergoing a PAC procedure. After premedication with paracetamol, fentanyl iv was given and general anesthesia was induced and maintained with sevoflurane (LMA). Prior to surgery, a modified SPB using the SIFB access was performed. With US (linear probe, 15 Hz) the 3rd rib was localized in the midaxillary line. With a 5 cm needle 0.4 ml/kg of 0.375% ropivacaine was administered in the intercostal-serratus plane covering the 2nd-4th ALB of ICN. Postoperatively 0.25 mg/kg pethidine was prescribed as rescue analgesia if the NRS score was >4. In the recovery room skin numbness was tested by tapping the skin upon the PAC. Results: In all cases there was no hemodynamic response after incision and all patients experienced a NRS lower than 4 postoperatively, with numbing of the skin upon the PAC area. No analgesia was needed in the recovery room in any case, and no complications have been recorded Conclusion: The modified SPB seems to be a promising analgesic approach for PAC procedures in pediatric patients and opening a new gate in analgesia for thoracic wall surgery in children.
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