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Abstract
Background and Aims A 50 year-old male, ASA II has had suffered high energy blunt thoracic trauma from a road traffic accident presented with left-sided thoracic and upper limb trauma. On presentation had mild respiratory distress despite being hemaodynamically stable and an oxygen saturation of 93% on room air. Head and cervical spine were negative. Thoracic scan showed displaced rib fractures 1st to 7th and concomitant ipsilateral severe lung contusion, fractured scapula, clavicle and three thoracic vertebrae. Patient required fixation of four ribs and his elbow. Neighter the vertebrae, nor the clavicular and scapular fractures needed operative treatment.
Methods In order to facilitate extubation and physiotherapy a superficial serratus anterior catheter were placed under ultrasound guidance and once loaded with 20 mL bupivacain 0.25% patient succesfully extubated on high-flow nasal cannula oxygen with 0/10 chestpain at rest. The severe pain around the clavicle and scapula managed effectively with a superior trunk catheter of the brachial plexus instead of interscalene to spare the phrenic nerve. Bolusing with 6 mL of Lidocain 1% provided complete analgesia with intact diaphragmatic movement on ultrasound. Continuous blocks were accomplished by intermittent boluses in every 12 hours instead of infusion in order to facilitate mobilization.
Results The effectivity of the intermittent blocks judged by low pain scores and superb respiratory function.
Conclusions Sublatissimus serratus catheter provied efficient pain relieve after thoracic surgery. Superior trunk catheter and low volume LA covers clavicle and scapula while preserving diaphragmatic function.