Bhalla Paul I, Solomon Stuart, Zhang Ray, Witt Cordelie E, Dagal Arman, Joffe Aaron M
Department of Anesthesiology and Pain Medicine, Harborview Medical Center, Seattle, Washington, USA.
Department of Surgery, University of Washington, Seattle, Washington, USA.
Trauma Surg Acute Care Open. 2021 Jan 8;6(1):e000621. doi: 10.1136/tsaco-2020-000621. eCollection 2021.
Pain from rib fractures is associated with significant pulmonary morbidity. Epidural and paravertebral blocks (EPVBs) have been recommended as part of a multimodal approach to rib fracture pain, but their utility is often challenging in the trauma intensive care unit (ICU). The serratus anterior plane block (SAPB) has potential as an alternative approach for chest wall analgesia.
This retrospective study compared critically injured adults sustaining multiple rib fractures who had SAPB (n=14) to EPVB (n=25). Patients were matched by age, body mass index, American Society of Anesthesiology Physical Status, whether the patient required intubation, number of rib fractures and injury severity score. Outcome measures included hospital length of stay, ICU length of stay, preblock and post block rapid shallow breathing index (RSBI) in intubated patients, pain scores and morphine equivalent doses administered 24-hour preblock and post-block in non-intubated patients, and mortality.
There were no demographic differences between the two groups after matching. Nearly all of the patients who received either SAPB or EPVB demonstrated a reduction in RSBI or pain scores. The preblock RSBI was higher in the serratus anterior plane block group, but there was no difference between any of the other outcome measures.
This retrospective study of our institutional data suggests no difference in efficacy between the serratus anterior plane block and neuraxial block for traumatic rib fracture pain in critically ill patients, but the sample size was too small to show statistical equivalence. Serratus anterior plane block is technically easier to perform with fewer theoretical contraindications compared with traditional neuraxial block. Further study with prospective comparative trials is warranted.
Retrospective matched cohort; Level IV.
肋骨骨折引起的疼痛与显著的肺部并发症相关。硬膜外阻滞和椎旁阻滞（EPVBs）已被推荐作为肋骨骨折疼痛多模式治疗方法的一部分，但在创伤重症监护病房（ICU）中其应用往往具有挑战性。前锯肌平面阻滞（SAPB）有潜力作为胸壁镇痛的替代方法。
这项回顾性研究比较了严重受伤的多发肋骨骨折成年患者，其中接受前锯肌平面阻滞（n = 14）的患者与接受椎旁阻滞（n = 25）的患者。患者根据年龄、体重指数、美国麻醉医师协会身体状况分级、是否需要插管、肋骨骨折数量和损伤严重程度评分进行匹配。观察指标包括住院时间、ICU住院时间、插管患者阻滞前和阻滞后的快速浅呼吸指数（RSBI）、疼痛评分以及非插管患者阻滞前和阻滞后24小时给予的吗啡等效剂量，还有死亡率。
匹配后两组在人口统计学方面无差异。几乎所有接受前锯肌平面阻滞或椎旁阻滞的患者RSBI或疼痛评分均有所降低。前锯肌平面阻滞组的阻滞前RSBI较高，但其他任何观察指标之间均无差异。
这项基于我们机构数据的回顾性研究表明，对于重症患者创伤性肋骨骨折疼痛，前锯肌平面阻滞和神经轴阻滞在疗效上无差异，但样本量过小，无法显示统计学等效性。与传统神经轴阻滞相比，前锯肌平面阻滞在技术上更容易实施，理论上的禁忌证更少。有必要进行进一步的前瞻性对照试验研究。
回顾性匹配队列研究；IV级。
