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CASE SERIES: SERRATUS ANTERIOR PLANE BLOCK (SAPB) FOR LATISSIMUS DORSI TENDON TRANSFER SURGERY
ESRA Academy. Lim V. Sep 8, 2016; 138358
Topic: Peripheral Nerve Blocks
Vera Qinyi Lim
Vera Qinyi Lim

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Abstract
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Background and Aims:

The SAPB can provide analgesia for breast, thoracic1 and shoulder surgeries2. It is a relatively easy block to perform with possibly less serious complications compared to paravertebral and central neuraxial blocks. The SAPB blocks the long thoracic nerve, which lies on (and also supplies) the serratus anterior muscle, and likely the thoracodorsal nerve (which supplies the latissimus dorsi (LD) muscle).

LD tendon transfer surgery is done for irreparable postero-superior tear of the rotator cuff tendons in the active patient. It is associated with moderate pain postoperatively. It involves an L-shaped incision along the anterior belly of the LD and the posterior axillary line; and a second incision over the antero-lateral aspect of the shoulder. Brachial plexus block (BPB) is usually done but does not cover the L-shaped incision site. Thus, we sought to evaluate the SAPB in providing analgesia to this area.

Methods:

We describe three cases where SAPB with BPB and one case where paravertebral block with BPB were done. 

Informed consent was obtained. All surgeries were performed under general anaesthesia with nerve blocks given pre-induction.

Results:


Patient 4 had severe pain in PACU. The paravertebral block may not have covered the whole extent of the incision. All four patients underwent physiotherapy about 24 hours post-block and tolerated it well. All were discharged on first or second postoperative day.

Conclusions:

SAPB is effective in providing analgesia over the incision site for LD tendon transfer surgery with physiotherapy-aiding effects even 24 hours post-block. SAPB may decrease postoperative analgesia requirements compared to paravertebral block.

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