Baccoli Francesco, Brunoni Beatrice, Zadek Francesco, Papoff Alessandra, Paveri Lorenzo, Torrano Vito, Fumagalli Roberto, Langer Thomas
Department of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy.
Department of Anesthesia and Intensive Care Medicina, Niguarda Ca' Granda, 20162 Milan, Italy.
J Clin Med. 2025 Mar 10;14(6):1864. doi: 10.3390/jcm14061864.
: Effective pain management in polytrauma patients with rib fractures is essential, particularly in the critical care setting. While epidural analgesia is considered the gold standard, it is not always feasible, necessitating alternative locoregional approaches. We present the case of a polytrauma patient with multiple, bilateral rib fractures and severe chest pain that hindered weaning from mechanical ventilation. A bilateral Serratus Anterior Plane Block (SAPB) was performed, with catheters placed for continuous administration of local anesthetics. Pain relief was immediate, enabling a rapid weaning from mechanical ventilation, safe extubation, and subsequent discharge to rehabilitation. A review of the literature on this technique in critically ill patients with thoracic trauma and multiple rib fractures is also presented. : We conducted a literature search up to November 2024, identifying studies evaluating the use of SAPB in critically ill patients with chest trauma and rib fractures. Eight studies were identified, including a total of 197 cases, of which only 3 involved a bilateral SAPB. Studies and published case reports demonstrated significant variability in analgesic protocols and reported outcomes. Notably, only two papers addressed specifically its role in facilitating weaning from mechanical ventilation. : Pain control is fundamental in managing severe chest trauma. This case and the reviewed literature suggest that the SAPB is a promising option when epidural analgesia is contraindicated or impractical. However, further studies are needed to define its place in clinical practice and optimize its use in critically ill patients.
对于多发伤合并肋骨骨折的患者，有效的疼痛管理至关重要，尤其是在重症监护环境中。虽然硬膜外镇痛被认为是金标准，但它并不总是可行的，因此需要替代的局部区域方法。我们报告了一例多发伤患者，该患者双侧多处肋骨骨折且胸痛严重，这阻碍了其从机械通气中撤机。实施了双侧前锯肌平面阻滞（SAPB），并放置导管持续给予局部麻醉药。疼痛立即缓解，使得能够迅速从机械通气中撤机、安全拔管，并随后出院接受康复治疗。本文还对该技术在重症胸外伤和多发肋骨骨折患者中的相关文献进行了综述。：我们进行了截至2024年11月的文献检索，确定了评估SAPB在重症胸外伤和肋骨骨折患者中应用的研究。共识别出8项研究，包括197例病例，其中只有3例涉及双侧SAPB。研究和已发表的病例报告显示，镇痛方案和报告的结果存在显著差异。值得注意的是，只有两篇论文专门探讨了其在促进机械通气撤机方面的作用。：疼痛控制是严重胸外伤管理的基础。该病例及综述文献表明，当硬膜外镇痛禁忌或不可行时，SAPB是一个有前景的选择。然而，需要进一步研究来确定其在临床实践中的地位，并优化其在重症患者中的应用。
