Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.
National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2021 Oct;33(5):788-793. doi: 10.1111/1742-6723.13724. Epub 2021 Jan 29.
Rib fractures are not only painful but are associated with morbidity and mortality, especially in older patients. The serratus anterior plane block (SAPB) is a plane block distant from major neurovascular bundles and may provide anaesthesia to a substantial area of the hemithorax. This pilot study was designed to assess if the SAPB can be safely and efficiently incorporated to the trauma reception workflow of an adult, level 1 trauma centre.
A convenience sample of 20 adult patients with at least two or more unilateral rib fractures received a SAPB performed by an emergency physician in addition to their standard analgesic regime. Time to perform the procedure, the number of attempts and complications were recorded as feasibility measures. Secondary outcome was the safety of the block. Numerical pain scores at pre-determined time points over 4 h, the diagnosis of hospital-acquired pneumonia, hospital length of stay and mortality at hospital discharge were collected to provide pilot data on effectiveness.
The median time to perform the procedure was 5.5 (interquartile range 4.6-10) mins with a range of 2-10.5 min. Most (16; 80%) SAPBs were completed in a single attempt. There were no documented complications. Median pain scores reduced from 6.5 (6-8) and were maintained at 3 (2-5) at 4 h after the SAPB.
The present study demonstrated the feasibility of ultrasound-guided SAPB among patients with multiple rib fractures in the ED. No complications were observed. Further prospective evaluation of analgesic effects in a larger cohort is indicated.
肋骨骨折不仅疼痛，而且与发病率和死亡率相关，尤其是在老年患者中。前锯肌平面阻滞（SAPB）是一种远离主要神经血管束的平面阻滞，可能为半胸部的大面积区域提供麻醉。本初步研究旨在评估 SAPB 是否可以安全且有效地纳入成人 1 级创伤中心的创伤接诊流程。
便利选取了 20 名至少有两处单侧肋骨骨折的成年患者，除了标准镇痛方案外，还由急诊医生行 SAPB。记录操作时间、尝试次数和并发症，以评估可行性。次要结局为阻滞的安全性。在 4 小时内的预定时间点收集数字疼痛评分、医院获得性肺炎的诊断、住院时间和出院时的死亡率，以提供关于有效性的初步数据。
操作时间中位数为 5.5（四分位距 4.6-10）分钟，范围为 2-10.5 分钟。大多数（16 例，80%）SAPB 单次尝试即完成。无记录到并发症。SAPB 后 4 小时疼痛评分中位数从 6.5（6-8）降至 3（2-5）。
本研究表明在 ED 中对多发性肋骨骨折患者进行超声引导的 SAPB 是可行的。未观察到并发症。需要进一步前瞻性评估更大队列的镇痛效果。
