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Abstract
Background and Aims The use of ultrasound to identify fascial tissue layers has led to an increasing number of novel techniques for analgesia of the chest wall. Subpectoral interfascial plane (SIP) blockade is a technique described by Fajardo et al. for ventilation weaning in rib fractures.
Methods A 61-year-old female was admitted to the intensive care unit post cardiac arrest due to major haemorrhage from a degloving scalp laceration. Return of cardiac output was achieved after one cycle of CPR and extubated within 24 hours. Pulmonary rehab proved difficult due to pain from multiple anterior rib & sternal fractures. Bilateral sternal catheters were inserted day 2 of her admission with loading dose of 40 ml 0.25% bupivacaine (1:400,000 adrenaline). Bupivacine 0.125% local anaesthetic infusions were set at 5 ml/hour with 6 hourly boluses of 20 ml 0.25% bupivacaine prescribed as required.
Results A 61-year-old female was admitted to the intensive care unit post cardiac arrest due to major haemorrhage from a degloving scalp laceration. Return of cardiac output was achieved after one cycle of CPR and extubated within 24 hours. Pulmonary rehab proved difficult due to pain from multiple anterior rib & sternal fractures. Bilateral sternal catheters were inserted day 2 of her admission with a loading dose of 40 ml 0.25% bupivacaine (1:400,000 adrenaline). Bupivacine 0.125% local anaesthetic infusions were set at 5 ml/hour with 6 hourly boluses of 20 ml 0.25% bupivacaine prescribed as required.
Conclusions This case supports the debate that repeated intermittent boluses are required to maintain analgesic efficacy for fascial plane blocks versus continuous local anaesthetic infusion.