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Serratus anterior plane blocks provide opioid-sparing analgesia in patients with isolated posterior rib fractures: a case series

  • Peter RoseEmail author
  • Reva Ramlogan
  • Timothy Sullivan
  • Anne Lui
Correspondence

To the Editor,

Serratus anterior plane (SAP) blocks provide effective analgesia in patients with antero-lateral rib fractures but are reportedly ineffective for posterior rib fractures.1,2 Serratus anterior plane injections consistently result in local anesthetic spread to lateral cutaneous branches of intercostal nerves that innervate the superficial antero-lateral chest wall, but were thought to spare the intercostal nerves that supply the posterior rib periosteum and intercostal muscles.3,4 Nevertheless, a recent cadaver study showed that, in the traumatized hemithorax, SAP injectate consistently reaches multiple intercostal nerves and spreads more posteriorly, reaching the medial border of the scapula.5 This study helps elucidate the mechanism of SAP block analgesia in rib fractures and provides an anatomical explanation for analgesia of posterior rib fractures.

At our institution, we have developed a protocol for early thoracic epidural or paravertebral analgesia to prevent...

Notes

Conflict of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Funding

None.

References

  1. 1.
    El-Boghdadly K, Wiles MD. Regional anaesthesia for rib fractures: too many choices, too little evidence. Anaesthesia 2019; 74: 564-8.CrossRefGoogle Scholar
  2. 2.
    Jadon A, Jain P, Motaka M. Serratus anterior plane block failed to relieve pain in multiple fractured ribs: report of two cases. J Recent Adv Pain 2017; 3: 50-3.CrossRefGoogle Scholar
  3. 3.
    Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 2013; 68: 1107-13.CrossRefGoogle Scholar
  4. 4.
    Mayes J, Davison E, Panahi P, et al. An anatomical evaluation of the serratus anterior plane block. Anaesthesia 2016; 71: 1064-9.CrossRefGoogle Scholar
  5. 5.
    Johnston DF, Black ND, O’Halloran R, Turbitt LR, Taylor SJ. Cadaveric findings of the effect of rib fractures on spread of serratus plane injections. Can J Anesth 2019; 66: 738-9.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyThe Ottawa HospitalOttawaCanada
  2. 2.Department of AnesthesiaUniversity of OttawaOttawaCanada

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