serratus anterior plane block
| Plane block for chest wall injuries (and surgeries) | |
|---|---|
| Indication | Rib fractures Chest drain insertion? |
| Contraindication | Allergy to local anaesthetic |
| Nerves blocked | Intercostal (lateral cutaneous) nerves that pierce serratus anterior Long thoracic nerve Thoracodorsal nerve |
| Kit | - US and probe cover - 50mm block needle - 20ml 0.5% levobupivacaine + 20ml 0.9% NaCl - as rule of thumb for patients >50 kg |
| Preparation | As for any Regional anaesthesia - AAGBI monitoring, availability of intralipid Patient positioning: supine, arm abducted to 90 deg |
| Technique/landmark | Probe positioning: transverse linear probe placed transversely (parallel to rib) in mid-axillary line - Needle in-plane - going through Latissimus dorsi - Use Doppler view to identify thoracodorsal artery - Superficial or deep possible (whether you go through serratus anterior or not) |
| Ongoing management | As per block guidance |
sonoanatomy
RCEM