Ultrasound-guided Continuous Serratus Anterior Plane Block versus Ultrasound-Guided Continuous Thoracic Paravertebral Block for Analgesia in Multiple Traumatic Rib Fractures

Abstract

Background: Rib fractures are the most common of all chest injuries. The aim of study was comparing the analgesic efficacy of ultrasound (US)- guided continuous serratus anterior plane (SAP (block and ultrasound- guided continuous thoracic paravertebral block) TPVB (in patients with multiple traumatic rib fractures.       Methods: This prospective randomized study was conducted over 70 patients of either sex aged between 22-65 years with unilateral multiple traumatic fracture ribs (≥ 3 fractured ribs) in ICU. Patients were randomly allocated into two equal groups (35 patients each): Group I (TPVB): received US guided continuous TPVB using bupivacaine 0.25% for 4 days. Group II (SAP block): received US-guided continuous SAP block using bupivacaine 0.25% for 4 days. Pain severity using visual analogue scale (VAS) at rest and on coughing, respiratory rate (RR), pulmonary function tests, arterial blood gases were measured before and after administration of the blocks at regular intervals. Hemodynamic changes, rescue morphine analgesic dose, length of hospital stay and complications of the two techniques were also recorded. Results: Both blocks provided significant decrease in VAS scores at rest and on coughing at all assessment times after blocks as compared to the pre-block values (P value< 0.05). There was no significant difference between both groups regarding the VAS scores at rest and on coughing. Both blocks provided significant decrease in RR and increase in FVC and FEV1 after blocks as compared to pre-block values (P value< 0.05). Continuous SAP block and TPVB provided significant increase in PaO2, SaO2 after both blocks as compared to pre-block values (P value< 0.05). There was no significant difference between both groups regarding morphine requirements, pulmonary functions and ABG parameters. SAP block had shorter block performance time and better needle visibility score than TPVB. Conclusions: Continuous SAP block is a safe and effective alternative to the TPVB for pain relief in patients with unilateral multiple fracture ribs. Both techniques improved the pulmonary functions and the arterial oxygenation without side effects. The SAP block had shorter block performance time with better needle visibility score than the TPVB.