Ultrasound-guided serratus plane block for ED rib fracture pain control

Rib fractures are common and painful; providing effective pain relief promotes optimal pulmonary function, thereby preventing complications such as pneumonia and respiratory failure. Opioids, long considered the criterion standard analgesic, have significant drawbacks including respiratory depression, suppression of the cough reflex, and delirium. Regional anesthetic techniques such as intercostal and paravertebral blocks or epidurals can be time-consuming with significant risks and remain uncommon in the typical emergency department. The serratus anterior plane block (SAPB) holds promise to be a technically simple, relatively safe, and effective intervention for emergency treatment of rib fracture pain. The technical skill required is on par with an ultrasound-guided femoral nerve block for hip fracture. At itsmost simple, the block involves using ultrasound to inject a 20-to 40-mL bolus of local anesthetic into the space between the surface of the ribs (external intercostal) and the overlyingmuscle (serratus anterior) centered over the rib fractures. Once injected, the local first anesthetizes the lateral cutaneous branches of the intercostal nerves, then as the bellowingmotion of the thoracic wall promotes dispersal, it soaks towards the intercostal space and the root intercostal nerves, spreading up and down several thoracic levels to achieve multilevel analgesia. Further researchwill clarify questions about the optimal location of SAPB for various rib fracture patterns, the volume and concentration of local anesthetic, the role of injected adjuncts, and expected duration of analgesia. Herein we present the first description of a SAPB successfully used for rib fracture analgesia in the emergency department.