Bilateral continuous serratus anterior plane block: An effective alternative for bilateral multiple rib fracture analgesia
Anju Gupta
, Aasim Ahmed, Amit Kumar Malviya
Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
Keywords: Multiple trauma, nerve block, pain management, pulmonary atelectasis, rib fractures, ultrasonography
Abstract
Pain due to rib fracture leads to respiratory impairment and bilateral fractures impact respiratory mechanics in the worst manner. Thoracic epidural analgesia is the gold standard for bilateral rib fractures but is technically difficult, entails potentially serious complications, and necessitates patient repositioning. Ultrasound-guided serratus anterior plane block (SAPB) has recently gained favor for alleviating thoracic pain and can be performed in patients lying supine, rendering it particularly useful in polytrauma patients who are unable to sit up or turn lateral for regional blocks on the back. Use of continuous bilateral SAPB for rib fractures has been underutilized. We report a case of a polytrauma patient who had bilateral multiple rib fracture along with vertebral and pelvic fractures due to which she was in severe pain and was unable to move to provide any kind of positioning for the blocks. Bilateral SAPB provided effective pain relief and facilitated early recovery and pulmonary rehabilitation of the patient.
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