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Abstract
Background and aims Approximately 21% of patients admitted to trauma centres with chest trauma present MRF.1 Severe pain associated can lead to hypoventilation and respiratory complications in 31% of cases.2 3 Epidural and multimodal analgesia versus opioids are recommended in pain management.2 Opioids present significant side effects. We hypothesized that SABP 4 5 could provide safe and effective analgesia, extended by addiction of dexamethasone to local anaesthetic solution, and reduce respiratory complications, enhancing recovery of a better mechanical lung function.
Methods 4 patients (BMI 30±3, age 60±18) admitted to ED for politrauma with lateral and posterior MRF (6±2) and severe pain (NRS>5), impairing maximal inspiration and coughing, were treated with multimodal analgesia+ SAPB (ethics committee approval obtained).
We injected 0,25%-levobupivacaine 30 ml and dexamethasone (8 mg) towards the serratus plane on the midaxillary line at 5th rib level with ultrasound guidance.
We registered RR, PaO2/FiO2 and NRS at rest (NRSr), during maximal inspiration (NRSi) and coughing (NRSc) before SABP (T0), after 15 minutes (T1) and after 4h (T2). At T0 and T2 we performed diaphragmatic ultrasound (diaphragm thickening ratio%, DTRr and DTRi).
Results All patients had benefits: NRSr, NRSi and NRSc strongly decreased at T1; benefits were maintained at T2 (Graph 1). Both DTRr and DTRi improved at T2 (Graph 2). Respiratory rate fell from 32±5 to 18±3 at T1, PaO2/FiO2 remained ≥270; deeper breathing allowed 20% reduction in FiO2. No patient asked for rescue analgesia. Analgesia duration was 43±6h. No patient had respiratory complication requiring mechanical ventilation.
Conclusions Both clinical and instrumental patterns suggest that SAPB is safe and provides effective opioid-sparing analgesia in MRF. It improves diaphragm function and could reduce respiratory complications.