Serratus anterior block for pain relief in multiple rib fractures: Case report (serratus anterior block in multiple rib fractures)

Nataša Ilić,Radomir Ilić

doi:10.5937/sjait1904081i

Abstract

Introduction: Chest trauma is the most common cause of multiple fractured ribs. Multiple rib fractures result in intensive pain and can be a cause of respiratory failure and pneumonia. Thoracic epidural and thoracic paravertebral blocks are effective but potentially invasive techniques to relieve the pain in patients with multiple rib fractures. Ultrasound guided serratus anterior plane block is a relatively newer technique that is less invasive, easier to perform, with low risk of complications. Case report: 34-year-old patient with chest trauma and multiple rib fractures suffering with intensive pain regardless of multimodal intravenous analgesia was given bilateral serratus anterior plane block. Under ultrasound guidance, a bolus dose of 20 ml 0.25% levobupivacaine and 4 mg of Dexamethasone was injected in the space between the serratus anterior and latissimus dorsi muscles. Catheters were inserted and an infusion of 0.0625% levobupivacaine was given at 10 ml / 2-4 hr. Pain scores were recorded with Numerical Rating Scale (NRS) before and after the block. Patient had pain relief following the block of 50% with in an hour, as pain score before block was 10/10 NRS while after block was 5/10 NRS. After continuous infusion of local anesthetic pain score was 0-1/10. No additional doses of analgesics were required. Conclusion: In our patient serratus anterior plane block provided effective analgesia in patient with multiple rib fractures. The serratus anterior plane block can be an alternative to thoracic epidural and paravertebral blocks.

Highlights

Chest trauma is the most common cause of multiple fractured ribs
Multiple rib fractures result in intensive pain and can be a cause of respiratory failure and pneumonia[2]
Thoracic epidural and thoracic paravertebral blocks are effective but invasive techniques to relieve the pain caused by multiple rib fractures[2]

Summary

Introduction

Chest trauma is the most common cause of multiple fractured ribs[1]. Multiple rib fractures result in intensive pain and can be a cause of respiratory failure and pneumonia[2]. That provides analgesia for the thoracic wall by blocking the lateral cutaneous branches of intercostal nerves from T2– T9 levels[3] This technique is less invasive, easier to perform, with low risk of complications[1,2,3]. We present a case report of a patient with chest trauma and multiple rib fractures who had severe pain, refractory to intravenous multimodal analgesia. A 34 years old male patient, American Society of Anesthesiologists (ASA) physical status grade III was admitted in the emergency department of Clinical center of Vojvodina with spine and chest trauma after fall from 4 meters height On arrival he was conscious, oriented (Glasgow Coma Score (GCS) 15), without neurological deficits. After tracheostomy sedation was left out, intravenous multimodal analgesia continued, and patient was awake on pressure support mode of mechanical ventilation, experiencing intensive pain and weaning from mechanical ventilation was very difficult. Patient was discharged to the Clinic for thoracic surgery in Sremska Kamenica with pain intensity score on NRS of 2

Discussion

Conclusion