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B230 Continuous serratus anterior plane block provides analgesia in multiple rib fractures: a case report
  1. V Tsapara,
  2. M Perente,
  3. C Stachtari,
  4. P Sarri-Floridou,
  5. V Tzanakopoulou and
  6. E Koraki
  1. Georgios Papanikolaou, General Hospital of Thessaloniki, Dept of Anaesthesiology and Pain Medicine, Thessaloniki, Greece


Background and Aims The aim of our study is to assess the effectiveness of serratus anterior block and placement of a catheter for continuous analgesia, in a female patient with fractures of the 4th, 5th and 12th rib and pneumothorax on the same side,who suffered from severe, refractory pain,after a fall of a height of 3,5 meters.

Methods Under sonographic guidance the landmarks for serratus anterior block were identified: latissimus dorsi and serratus anterior muscles. Using a Contiplex needle, 80mm and 18G and an in plane approach and after hydrodissection with dextrose to confirm that the needle tip was placed in the interfascial space 30 mls ropivacaine 0,2% were injected. A catheter was then advanced through the needle and an infusion pump including 200 ml ropivacaine 0,2% with an infusion rate of 5 ml/h was used in order to achieve continuous analgesia.

Results Immediately after performing the serratus block, a significant improvement regarding the pain was observed and the NRS was reduced from 8/10 to 2/10. During the follow up, the infusion rate remain stable and a total of three bolus doses with 20 ml ropivacaine 0,1% were performed, at the 1st, 2nd and 3rd based on the NRS of the patient. On the 4th day, NRS was 1/10 and the catheter was decided to removed. The patient was free of pain and fully satisfied with our intervention.

Conclusions The serratus block with placement of a continuous nerve block catheter comprises a safe and effective method for analgesia in patients with rib fractures.

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