Ultrasound-guided serratus anterior plane block for rib fracture-associated pain management in emergency department

Context: Traumatic Rib fractures are common and painful conditions to present in the emergency department. Ultrasound-guided serratus anterior plane block (SAPB) is a newer technique which is being used for managing postthoracotomy, thoracoscopic surgery, or post mastectomy pain by the anesthetists. However, we have recently started utilizing this novel technique in our emergency department for rib fracture patients with severe pain. Settings and Methods: We present a case series of 10 patients of multiple rib fractures (MFRs) with persistent Defense and Veterans Pain Rating Scale 7 or more even after intravenous analgesics where this block was applied by trained emergency physicians (EP). Results: Following SAPB median (+/- IQR) pain score reduction was 5 (+/- 4) at 30 min and 7.5 (+/- 2) after 60 min of administering the block. There were no incidences of block failure or block-related complications in our series. Conclusions: Ultrasound-guided SAPB can be used safely by trained EP in the emergency department to relieve acute severe analgesic-resistant pain in MFR patients.