Pais João V, Barros Mariana S, Cavalete Sónia M, Cardoso Helder P
Anesthesiology, Unidade Local de Saúde Tâmega e Sousa, Penafiel, PRT.
Cureus. 2025 Jan 12;17(1):e77332. doi: 10.7759/cureus.77332. eCollection 2025 Jan.
Patients with multiple bilateral rib fractures frequently experience intense pain and limited thoracic mobility, leading to complications such as reduced coughing efficiency, pulmonary infection, and respiratory failure. While thoracic epidural analgesia is often considered the gold standard for pain management in these cases, its use is limited by contraindications and the need for patient positioning that exposes the back. The serratus anterior plane block, guided by ultrasound, offers a promising alternative for managing thoracic pain, particularly for polytrauma patients who cannot sit up or assume lateral positions required for traditional regional blocks. This case report describes a patient admitted to the intensive care unit following a fall that caused multiple bilateral rib fractures. Due to contraindications for epidural analgesia related to coagulopathy, bilateral serratus anterior plane blocks were performed with catheter placement on each side, providing effective pain relief and improving respiratory function.
多发性双侧肋骨骨折患者经常会经历剧烈疼痛和胸廓活动受限，从而导致诸如咳嗽效率降低、肺部感染和呼吸衰竭等并发症。虽然胸椎硬膜外镇痛通常被认为是这些病例疼痛管理的金标准，但其应用受到禁忌症以及需要患者暴露背部进行体位摆放的限制。在超声引导下的前锯肌平面阻滞为胸廓疼痛管理提供了一种有前景的替代方法，特别是对于那些无法坐起或采取传统区域阻滞所需侧卧位的多发伤患者。本病例报告描述了一名因跌倒导致多发性双侧肋骨骨折而入住重症监护病房的患者。由于与凝血功能障碍相关的硬膜外镇痛禁忌症，遂在两侧进行了前锯肌平面阻滞并留置导管，有效缓解了疼痛并改善了呼吸功能。
