Benesch Tara, Mantuani Daniel, Nagdev Arun
Highland General Hospital, Department of Emergency Medicine, Oakland, California.
Clin Pract Cases Emerg Med. 2021 Feb;5(1):117-120. doi: 10.5811/cpcem.2020.12.50184.
The serratus anterior plane block (SAPB) has been shown to effectively treat pain following breast surgery, thoracotomies, and rib fractures. We present the first reported case of a bilateral ultrasound-guided SAPB in a multimodal analgesic regimen after an acute large, thoracic, deep partial-thickness burn.
A 72-year-old male presented in severe pain two days after sustaining a deep partial- thickness burn to his anterior chest wall after his shirt caught on fire while cooking. The area of injury was on bilateral chest walls, and the patient was consented for bilateral SAPBs at the level of the third thoracic ribs (T3). With ultrasound guidance, a mixture of ropivacaine and lidocaine with epinephrine was injected into the fascial plane overlying bilateral serratus muscles at T3. The patient reported complete resolution of pain for approximately 15 hours and required minimal additional intravenous analgesia.
The ultrasound-guided SAPB may be an excellent addition to the multimodal analgesic regimen in superficial and partial-thickness burns of the anterior chest wall.
前锯肌平面阻滞（SAPB）已被证明能有效治疗乳房手术、开胸手术和肋骨骨折后的疼痛。我们报告了首例急性大面积胸部深度部分厚度烧伤后，在多模式镇痛方案中进行双侧超声引导下SAPB的病例。
一名72岁男性，在做饭时衬衫着火，导致前胸壁深度部分厚度烧伤，两天后出现剧痛。损伤部位在双侧胸壁，患者同意在第三胸椎（T3）水平进行双侧SAPB。在超声引导下，将罗哌卡因和利多卡因加肾上腺素的混合液注入T3水平双侧前锯肌上方的筋膜平面。患者报告疼痛完全缓解约15小时，仅需极少的额外静脉镇痛。
超声引导下的SAPB可能是前胸壁浅表和部分厚度烧伤多模式镇痛方案中的一个极佳补充。
