Serratus plane block: a novel ultrasound-guided thoracic wall nerve block
Anaesthesia 2013;68:1107-1113 doi:10.1111/anae.12344
Presented by: Dr. A. Gańska
Background
- The serratus plane block is an alternative block to paravertebral block and thoracic epidural (which are more challenging and have higher potential side-effect profile
- It can provide a long lasting analgesia for breast, axilla surgery and prevention of acute pain progressing to chronic pain
- It has fewer side-effects, is safe and easy to perform
Design and Settings
- Descriptive study on 4 volunteers and 3D reconstruction of local anaesthetic spread using fat-suppression MRI imaging
Subjects
- 4 female volunteers
Intervention
- USS guided injections, two per volunteer of solution of 0.4ml/kg 0.125% levobupivacaine mixed with 0.1mmol/kg gadolinium.
- First superficial to serratus anterior
- Second underneath the muscle at level of 5th rib in midaxillary line.
- Thoracodorsal artery was used as an extra reference point
Outcomes
- Test of sensory loss after 30min with hypodermic needle
- MRI scan after 1h to show distribution of gadolinium
- Two observers compared images with MRI atlases
Results
- T2 – T9 dermatomal paresthesia
- Weak crossed-arm adduction movement
Conclusions
- injection I: 752min duration of paresthesia for sensory nerves and 43min for motor nerves
- Injection II: 386min duration of paresthesia for sensory nerves and 150min for motor nerves
- MRI showed good spread with both injections
Study limitations
- Descriptive study on volunteers
- Small number of participants
- Needs randomised controlled trial
- MRI distribution of gadolinium may mimic fat tissue, image analysis software had to be used
- Possibility of false impression of extent of LA spread – there was greater extension of the clinical effect then MRI suggested
Potential for impact
- The serratus plane lock appears to give predictable and long lasting regional anaesthesia
- Alternative to surgical LA infiltration, paravertebral blocks, thoracic epidural and intercostal nerves blocks
- Compared with above this technique could be better for day case surgery
- Superficial block was more effective
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