scholarly journals Comparison of serratus anterior plane block with epidural and paravertebral block in critically ill trauma patients with multiple rib fractures

2021 ◽  
Vol 6 (1) ◽  
pp. e000621
Author(s):  
Paul I Bhalla ◽  
Stuart Solomon ◽  
Ray Zhang ◽  
Cordelie E Witt ◽  
Arman Dagal ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Critically Ill ◽  
Outcome Measures ◽  
Rib Fractures ◽  
Serratus Anterior ◽  
Multiple Rib Fractures ◽  
Neuraxial Block ◽  
Pain Scores ◽  
Anterior Plane

BackgroundPain from rib fractures is associated with significant pulmonary morbidity. Epidural and paravertebral blocks (EPVBs) have been recommended as part of a multimodal approach to rib fracture pain, but their utility is often challenging in the trauma intensive care unit (ICU). The serratus anterior plane block (SAPB) has potential as an alternative approach for chest wall analgesia.MethodsThis retrospective study compared critically injured adults sustaining multiple rib fractures who had SAPB (n=14) to EPVB (n=25). Patients were matched by age, body mass index, American Society of Anesthesiology Physical Status, whether the patient required intubation, number of rib fractures and injury severity score. Outcome measures included hospital length of stay, ICU length of stay, preblock and post block rapid shallow breathing index (RSBI) in intubated patients, pain scores and morphine equivalent doses administered 24-hour preblock and post-block in non-intubated patients, and mortality.ResultsThere were no demographic differences between the two groups after matching. Nearly all of the patients who received either SAPB or EPVB demonstrated a reduction in RSBI or pain scores. The preblock RSBI was higher in the serratus anterior plane block group, but there was no difference between any of the other outcome measures.DiscussionThis retrospective study of our institutional data suggests no difference in efficacy between the serratus anterior plane block and neuraxial block for traumatic rib fracture pain in critically ill patients, but the sample size was too small to show statistical equivalence. Serratus anterior plane block is technically easier to perform with fewer theoretical contraindications compared with traditional neuraxial block. Further study with prospective comparative trials is warranted.Level of evidenceRetrospective matched cohort; Level IV.

scholarly journals Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

2020 ◽  
Vol 45 (5) ◽  
pp. 351-356 ◽  
Author(s):  
Laura Beard ◽  
Carl Hillermann ◽  
Emma Beard ◽  
Sue Millerchip ◽  
Rajneesh Sachdeva ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Negative Binomial ◽  
Rib Fractures ◽  
Serratus Anterior ◽  
Regional Analgesia ◽  
Cross Sectional ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Significant Difference ◽  
Anterior Plane

BackgroundThere is a paucity of data comparing effectiveness of various techniques for pain management of traumatic rib fractures. This study compared the quality of analgesia provided by serratus anterior plane (SAP) catheters against thoracic epidural (TEA) or paravertebral catheters (PA) in patients with multiple traumatic rib fractures (MRFs).Methods354 patients who received either SAP, TEA or PA at two tertiary referral major trauma centers in the UK were included (2016–2018). Primary outcome were change in inspiratory volumes and pain scores. Secondary outcomes included in-hospital mortality, along with the length of stay in hospital and critical care. Data were analyzed using linear, log-binomial and negative binomial regression models.Main resultsAcross all blocks, there was a mean (SD) increase in inspiratory volume postblock of 789.4 mL (479.7). Ninety-eight per cent of all participants reported moderate/severe pain prior to regional analgesia, which was reduced to 34% postblock. There was no significant difference in the change in inspiratory volume or pain scores between the TEA, PA or SAP groups. Overall crude mortality was 13.2% (95% CI 7.8% to 18.7%). In an adjusted analysis and compared with TEA, in-hospital mortality was similar between groups (relative risk (RR) 0.4, 95% CI 0.1 to 1.0) and (RR 0.5, 95% CI 0.2 to 1.6) for SAP and PA, respectively.ConclusionSAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.

scholarly journals Serratus Anterior Plane Block for Multiple Rib Fractures

2014 ◽  
Vol 4;17 (4;7) ◽  
pp. E553-E555 ◽  
Author(s):  
Nishad Poolayullathil K Kunhabdulla
Keyword(s):  
Rib Fractures ◽  
Serratus Anterior ◽  
Multiple Rib Fractures ◽  
Anterior Plane

scholarly journals Ultrasound-guided continuous serratus anterior plane block for combined trauma: case series

2019 ◽  
Vol 13 (1-4) ◽  
pp. 22-26
Author(s):  
A. T. Ibragimov ◽  
E. E. Antipin ◽  
D. A. Svirsky ◽  
B. N. Shah ◽  
S. V. Kovalev ◽  
...  
Keyword(s):  
Side Effects ◽  
Chest Trauma ◽  
Case Series ◽  
Rib Fractures ◽  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Multiple Rib Fractures ◽  
Trauma Case ◽  
Anterior Plane

Clinical cases of the use of continuous ultrasound-guided Serratus anterior plane block in patients with severe combined trauma, dominant chest trauma and multiple rib fractures. The method allows for excellent long-term analgesia without the need for additional administration of the drug, there are no side effects.

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