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Impact of serratus plane block on pain scores and incentive spirometry volumes after chest trauma

Authors Hernandez N, de Haan J, Clendeninn D, Meyer DE, Ghebremichael S, Artime C, Williams G, Eltzschig H, Sen S

Received 6 March 2019

Accepted for publication 28 May 2019

Published 2 August 2019 Volume 2019:12 Pages 59—66


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Stefan Wirz

Nadia Hernandez,1 Johanna de Haan,1 Dallis Clendeninn,1 David E Meyer,2 Semhar Ghebremichael,1 Carlos Artime,1 George Williams,1 Holger Eltzschig,1 Sudipta Sen1

1Department of Anesthesiology, Houston’s McGovern Medical School, University of Texas Health Science Center, Houston, TX, 77030, USA; 2Department of Surgery, Houston’s McGovern Medical School, University of Texas Health Science Center, Houston, TX, 77030, USA

Background: Adequate pain control is difficult to achieve in patients with multiple rib fractures (MRF). Serratus plane block (SPB) is a novel technique for alleviating rib fracture pain. Several published case reports support this hypothesis.
Purpose: The purpose of this study was to evaluate the use of SPB in MRF at our level 1 trauma center.
Methods: Our hospital’s Regional Anesthesia Registry was queried for all trauma patients with MRF who underwent SPB between August 2014 and January 2018. Data were compared in each patient as a matched pair for the time periods before and after undergoing SPB. Thirty-four patients with similar baseline characteristics were enrolled.
Results: The median number of rib fractures was 7. Ordinal pain scores were found to be improved 4 hrs after SPB from median 7/10 to 3/10 (P<0.001). Incentive spirometry (IS) volumes recorded 4 and 24 hrs postserratus plane block showed a median increase of 150 and 175 mL from baseline, respectively (P<0.001). IS volumes recorded at 48 hrs showed a median increase of 300 mL from baseline (P<0.001). Respiratory rate decreased from a median value of 24.5 to 16 breaths/min (P<0.001). SpO2 was improved at 24 hrs from median 96% to 99% (P<0.001).
Conclusion: SPB improves pain scores and IS volumes in MRF. Because it is not limited by patient positioning or anticoagulation and has a better safety profile, it may offer a viable alternative to neuraxial techniques. Additional studies are necessary to evaluate its efficacy compared to neuraxial techniques.

Keywords: polytrauma, rib fractures, pain management, regional anesthesia

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