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