Nerve Block: Serratus Anterior: Difference between revisions
(Created page with "==Overview== *Injection of local anesthetic around the thoracic intercostal nerves to provide regional anesthesia to the anterolateral chest wall ==Indications== *Rib fractures *Rib contusions ==Contraindications== *Overlying soft tissue infection *Allergy to local anesthetic ==Equipment Needed== *High-frequency linear transducer *Sterile probe cover *Sterile gel *Chlorhexidine or betadine solution *Sterile gloves *1% lidocaine with epinephrine in syringe with 27-gaug...") |
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==Indications== | ==Indications== | ||
*Rib fractures | *Rib fractures <ref>Southgate SJ, Herbst MK. Ultrasound Guided Serratus Anterior Blocks. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538476/</ref> | ||
*Rib contusions | *Rib contusions | ||
| Line 11: | Line 11: | ||
==Equipment Needed== | ==Equipment Needed== | ||
* | *Ultrasound (linear transducer) w/ sterile probe cover | ||
*Sterile gloves | |||
*Sterile | |||
*Chlorhexidine or betadine solution | *Chlorhexidine or betadine solution | ||
*1% lidocaine with epinephrine in syringe with 27-gauge needle (for skin wheel) | *1% lidocaine with epinephrine in syringe with 27-gauge needle (for skin wheel) | ||
*0.5% bupivacaine in 30 ml syringe | *0.5% or 0.25% bupivacaine in 30 ml syringe. | ||
* | *18 gauge blunt needle | ||
*22-25 gauge peripheral nerve block needle with extension tubing | |||
**Alternatively, 22g spinal needle with IV extension tubing | **Alternatively, 22g spinal needle with IV extension tubing | ||
==Procedure== | |||
*Position patient in supine or lateral decubitus position (injured side up)<ref>https://templepocus.com/regional-anesthesia/b28jyz9rhr3n4b3chbdhhs7z62s7pb</ref> | |||
*Sterilize skin w/ antiseptic solution | |||
*Inject wheal of lidocaine into injection site | |||
*Place ultrasound probe lateral to the nipple in transverse orientation | |||
*Find the serratus anterior muscle overlying the ribs in the lateral chest wall | |||
*Using the in-plane technique, advance needle with dominant hand | |||
*Identify the pleural line prior to inserting the needle | |||
*Advance the needle toward the rib (you will feel a pop once through the fascia) | |||
*Connect tubing to needle and syringe. | |||
*Push 2-3 cc to confirm placement between the serratus anterior and latissimus dorsi. The two should separate freely. | |||
*Inject the remaining anesthetic | |||
==Complications== | ==Complications== | ||
*Nerve injury | |||
*Vascular injury | |||
*Rebound pain | |||
==See Also== | ==See Also== | ||
*[[Nerve blocks (main)]] | |||
*[[Local anesthetic systemic toxicity]] | |||
==External Links== | ==External Links== | ||
===Videos=== | |||
{{#widget:YouTube|id=3Qlo5MIdtEc}} | |||
==References== | ==References== | ||
Latest revision as of 18:15, 28 September 2022
Overview
- Injection of local anesthetic around the thoracic intercostal nerves to provide regional anesthesia to the anterolateral chest wall
Indications
- Rib fractures [1]
- Rib contusions
Contraindications
- Overlying soft tissue infection
- Allergy to local anesthetic
Equipment Needed
- Ultrasound (linear transducer) w/ sterile probe cover
- Sterile gloves
- Chlorhexidine or betadine solution
- 1% lidocaine with epinephrine in syringe with 27-gauge needle (for skin wheel)
- 0.5% or 0.25% bupivacaine in 30 ml syringe.
- 18 gauge blunt needle
- 22-25 gauge peripheral nerve block needle with extension tubing
- Alternatively, 22g spinal needle with IV extension tubing
Procedure
- Position patient in supine or lateral decubitus position (injured side up)[2]
- Sterilize skin w/ antiseptic solution
- Inject wheal of lidocaine into injection site
- Place ultrasound probe lateral to the nipple in transverse orientation
- Find the serratus anterior muscle overlying the ribs in the lateral chest wall
- Using the in-plane technique, advance needle with dominant hand
- Identify the pleural line prior to inserting the needle
- Advance the needle toward the rib (you will feel a pop once through the fascia)
- Connect tubing to needle and syringe.
- Push 2-3 cc to confirm placement between the serratus anterior and latissimus dorsi. The two should separate freely.
- Inject the remaining anesthetic
Complications
- Nerve injury
- Vascular injury
- Rebound pain
See Also
External Links
Videos
{{#widget:YouTube|id=3Qlo5MIdtEc}}
References
- ↑ Southgate SJ, Herbst MK. Ultrasound Guided Serratus Anterior Blocks. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538476/
- ↑ https://templepocus.com/regional-anesthesia/b28jyz9rhr3n4b3chbdhhs7z62s7pb