1. Serratus AnteriorSerratus Anterior
Plane BlockPlane Block
Dr. Ananth KumarDr. Ananth Kumar
Department of Anaesthesia and Perioperative medicineDepartment of Anaesthesia and Perioperative medicine
Westmead HospitalWestmead Hospital
25. How does SAPB work for
Rib fractures?
Conflicting evidence of spread to intercostal
space (and therefore intercostal nerve)
Possible direct spread to periosteum of rib #
Or ‘splinting’ of external intercostal muscle
?systemic L.A. absorption
27. How does SAPB work for
Rib fractures?
Conflicting evidence of spread to intercostal
space (and therefore intercostal nerve)
Possible direct spread to periosteum of rib #
Or ‘splinting’ of external intercostal muscle
?systemic L.A. absorption
31. In summary
Safe, fast, effective, versatile
Lateral rib # (hemithorax) 2 - 9
Superficial vs deep – go deep – possibly more
effective (but make sure you can visualise needle
and pleura at all times)
Caution – subcutaneous emphysema
Use high-volume of L.A i.e. 30-40mls (be mindful of
toxic doses)
Notas del editor
Boxer’s muscle - Function of serratus is to bring the scapula forwards
Linear array probe
The patient’s respiration will help spread the block.
Good for lateral rib #; not as good for extremely posterior or anterior – need to do erector spinae block
https://www.youtube.com/watch?v=2wiW3mq-zaI
4 volunteers
0.4ml/kg of 0.125% levobupiv
Sensory testing with hypodermic needle
Quality of anaesthesia – unsure?
Amount of levobupiv? And concentration
63 y.o.; A whole-body CT scan showed multiple, displaced fractures from the second to the ninth ribs on the right side, fracture of the contralateral clavicle, the sternum, and the first and second ribs on the left side; spinal X-ray showed an amyelic fracture of the body of L2.
There are also a couple more case reports of successfully avoiding mechanical ventilation due to efficacy of block
6 patients
Deep technique
Catheters were placed for up to 5 days
Only breakthrough was tramadol i.v
A prospective, randomized, observer–blinded, controlled study. 40 patients.
Compared with preoperative values, the mean arterial pressure in the SAPB group did not change significantly (p = 0.181), whereas it decreased significantly (p = 0.006) in the TEA group. VAS scores and the total dose of morphine consumed were comparable in the 2 groups.
For SAPB – if use 40mls – can cover 6 dermatomes as opposed to 4 with 20mls
