Clinical Application of Ultrasound-Guided Serratus Anterior Plane Block: Two Cases

Abstract

Ultrasound guided serratus plane block (SPB) which is performed on the interfascial plane between serratus ansterior and latissimus dorsi muscle has recently been described as a regional anesthetic technique to provide analgesia to the anterolateral chest wall. It provides analgesia of hemithorax via blockade of the lateral cutaneous branches of the thoracic intercostal nerves that pierce serratus anterior. In this case report, we applied ultrasound guided SPB to two patients. One was a patient who complained wide range of anterolateral chest pain due to chest wall pain syndrome, and had low platelet due to alcoholic liver cirrhosis. The other was a patient who complained lateral chest wall pain due to herpes zoster, and couldn't discontinue antiplatelet therapy due to recent percutaneous transluminal coronary angioplasty. In both cases, ultrasound guided SPB has some advantages than established thoracic regional block including multilevel intercostal nerve block, thoracic paravertebral block and epidural block. It provides wide range of analgesia with single injection. It is safer and easier to perform by using ultrasound. It could provide analgesia without hemodynamic instability. This technique could be a good alternative to established regional block in patient with wide range of unilateral chest wall pain, cardiovascular disease and bleeding tendency.