Serratus Anterior Plane Block for Thoracic Wall Pain

Background

 

The serratus anterior plane block (SAPB) is a field block that provides analgesia from T2 to T9 dermatomes of the hemithorax by anesthetizing the lateral cutaneous branches of the intercostal nerves in that area. It was first described in a 2013 study demonstrating long-lasting thoracic-wall anesthesia with no significant adverse effects (1). It has since been utilized by anesthesia for prophylactic treatment of post-thoracotomy and post-mastectomy pain (2-4) and has demonstrated utility for treatment of rib fracture pain in the acute setting (5)

This case series describes its use in the Emergency Department (ED) for patients with thoracic wall pain from rib fractures, herpes zoster and chest tube placement. 

Serratus Anterior Plane Block in the Emergency Department: A Case Series.

The Bottom Line 

 

Serratus anterior plane block, when performed by appropriately-trained physicians, is an effective and safe alternative to parenteral opioids and can provide significant, long-lasting analgesia for a variety of painful thoracic conditions. 

For more on the serratus anterior plane block see here:

Highland Ultrasound 

 

Case 26: Genicular Nerve Block for Knee Pain – A Novel Technique

A 68 year old female with no significant past medical history presents to the Emergency Department (ED) with one day of right knee pain after falling off her bicycle onto her right side. She was immediately unable to bear weight on her right leg. 

 

Vitals: T 98.3, HR 73, RR 18, BP 114/70, SpO2 99%

 

Right leg exam: mild right knee effusion. No ligamentous laxity. Tenderness to palpation over lateral joint line > medial joint line. Tenderness to palpation over proximal anterior tibia. Knee extension limited due to pain. Neurovascularly intact with soft compartments.

 

Radiographic imaging demonstrated an isolated right tibial plateau fracture depression of the lateral plateau. The patient reports she is in severe pain but dislikes taking both over-the-counter and opioid pain medications. 

What nerves may be targeted to provide pain relief to her knee while maintaining motor function? What anatomic landmarks should be used on ultrasound to identify the branches of this nerve?

This post was written by Julia Sobel MD, with editing from Jessica Oswald MD, Charles Murchison MD and Amir Aminlari MD.

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