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

Abhijit Nair,Sandeep Diwan

doi:10.7759/cureus.21322

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.

Highlights

BackgroundPatients sustain multiple rib fractures (MRFs) due to various etiologies like road traffic accidents, assault, falls from heights, etc
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 serratus anterior plane block (SAPB) was used for managing pain due to MRFs
Pain management offered for patients with MRFs could be either systemic analgesia or regional anesthesia (RA)

Summary

Introduction

Patients sustain multiple rib fractures (MRFs) due to various etiologies like road traffic accidents, assault, falls from heights, etc. There are several RA options that can be offered to alleviate pain following MRFs like thoracic epidural analgesia, paravertebral block, intercostal nerve block, serratus anterior plane block (SAPB), or erector spinae plane block [5,6,7,8,9,10]. When a SAPB is performed, it targets the lateral cutaneous branches of the thoracic intercostal nerves arising from the ventral rami of the thoracic spinal nerves These nerves traverse through the internal intercostal, external intercostal, and SA muscles to innervate the muscles of the anterolateral aspect thoracic cage. How to cite this article Nair A, Diwan S (January 17, 2022) Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Managing Pain Due to Multiple Rib Fractures: A Scoping Review. The secondary outcomes are pain scores and complications due to USguided SAPB if any

Methodology

Search Results

Discussion

Conclusions

Findings

Disclosures