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

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.