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BILATERAL SERRATUS PLANE BLOCKS; A NOVEL APPROACH TO BILATERAL RIB FRACTURE PAIN CONTROL IN A POLYTRAUMA PATIENT
Author(s): ,
Abouelmagd, R.*
Affiliations:
Kings College Hospital, Anaesthesia, London, United Kingdom
,
Kumar, A.
Affiliations:
Kings College Hospital, Anaesthesia, London, United Kingdom
Stack, C.
Affiliations:
Kings College Hospital, Anaesthesia, London, United Kingdom
ESRA Academy. Abouelmagd R. Sep 16, 2017; 196153; esra7-0262
Dr. Rasha Abouelmagd
Dr. Rasha Abouelmagd
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Abstract
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Background and Aims:

Pain associated with rib fractures is usually severe leading to hypoventilation and predisposing patients to atelectasis, retention of secretions and pneumonia. These factors combined with underlying lung damage, intrapulmonary shunting and altered breathing mechanics put these patients at a significant risk of high morbidity and mortality. We report a novel approach to management of these cases.

Methods:

A 77-year-old male polytrauma patient with multiple bilateral rib fractures, flail segment, manubrial and spinal fractures was referred for pain management after failure of conventional management. Thoracic epidural, as per King's protocol, was inappropriate  because of the multiple unstable vertebral fractures for which the patient was immobilised. We opted for bilateral serratus plane blocks with catheter insertion. Ultrasound guided, in-plane blocks were performed using 18-gauge Tuohy needle. The latissmus-dorsi and serratus muscles were identified at the nipple level, midaxillary line and 30mls levobupivacaine 0.25%, were injected between the muscles on each side and epidural catheters sited. Top-ups were prescribed 12-hourly.

Results:

The patient reported a remarkable drop in his pain scores 15 minutes post-block as well as 6 and 12 hours later (figure 1). The catheters were left in place for 7 days and were assessed on daily basis. No signs of local or systemic sepsis were noted.

Conclusions:

To our knowledge, the use of serratus plane blocks for bilateral rib fracture pain hasn’t been previously reported. Serratus plane blocks are easy to perform, relatively safe and reliable. They could have an important role in rib fracture pain management in situations where conventional methods are inappropriate.

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