Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb;5(1):117-120.
doi: 10.5811/cpcem.2020.12.50184.

Case Report: Bilateral Ultrasound-guided Serratus Anterior Plane Blocks for a Chest Wall Burn

Tara Benesch  1 , Daniel Mantuani  1 , Arun Nagdev  1
Affiliations

Case Report: Bilateral Ultrasound-guided Serratus Anterior Plane Blocks for a Chest Wall Burn

Tara Benesch et al. Clin Pract Cases Emerg Med. 2021 Feb.

Abstract

Introduction: The serratus anterior plane block (SAPB) has been shown to effectively treat pain following breast surgery, thoracotomies, and rib fractures. We present the first reported case of a bilateral ultrasound-guided SAPB in a multimodal analgesic regimen after an acute large, thoracic, deep partial-thickness burn.

Case report: A 72-year-old male presented in severe pain two days after sustaining a deep partial- thickness burn to his anterior chest wall after his shirt caught on fire while cooking. The area of injury was on bilateral chest walls, and the patient was consented for bilateral SAPBs at the level of the third thoracic ribs (T3). With ultrasound guidance, a mixture of ropivacaine and lidocaine with epinephrine was injected into the fascial plane overlying bilateral serratus muscles at T3. The patient reported complete resolution of pain for approximately 15 hours and required minimal additional intravenous analgesia.

Conclusion: The ultrasound-guided SAPB may be an excellent addition to the multimodal analgesic regimen in superficial and partial-thickness burns of the anterior chest wall.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Figure
Figure
Anatomical landmarks in the serratus anterior plane block. Above the rib lies the serratus anterior (SA), which is deep to the latissimus dorsi (LD). The targeted lateral cutaneous branches of the thoracic intercostal nerves (third to ninth thoracic vertebral level, or T3–T9, arrows), are in the fascial plane separating the SA and LD muscles.
Image 1
Image 1
Partial-thickness burn of the anterior chest wall in the patient prior to receiving bilateral serratus anterior plane blocks for pain.
Image 2
Image 2
An in-plane technique is used to inject the mixture of anesthetic (in this case, ropivacaine and lidocaine with epinephrine) between serratus anterior and latissimus dorsi muscles. Hydrodissection with 10 milliliters of normal saline prior to injecting anesthetic can assist with visualization of the fascial plane (white dots). The rib and pleura lie beneath the serratus anterior muscle (white arrows). Photo obtained with consent for demonstration purposes.
See this image and copyright information in PMC

References

    1. Gibran NS. Burns of the chest wall. In: Karmy-Jones R, Nathens A, Stern EJ, editors. Thoracic Trauma and Critical Care. Boston, MA: Springer; 2002.
    1. Griggs C, Goverman J, Bittner EA, et al. Sedation and pain management in burn patients. Clin Plast Surg. 2017;44(3):535–40. - PMC - PubMed
    1. Blanco R, Parras T, Mcdonnell JG, et al. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68(11):1107–13. - PubMed
    1. Hetta DF, Rezk KM. Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation. J Clin Anesth. 2016;34:91–7. - PubMed
    1. Ahiskalioglu A, Yayik AM, Demir U, et al. Preemptive analgesic efficacy of the ultrasound-guided bilateral superficial serratus plane block on postoperative pain in breast reduction surgery: a prospective randomized controlled study. Aesthetic Plast Surg. 2020;44(1):37–44. - PubMed