Evaluation of the Analgesic Efficacy of the Serratus Posterior Superior Intercostal Plane Block in Patients with Isolated Rib Fractures: A Case Series.

OBJECTIVE

To evaluate the analgesic efficacy of serratus posterior superior intercostal plane block (SPSIPB) in patients with isolated rib fractures.

DESIGN

Retrospective single-center case series.

SETTING

Tertiary academic medical center.

PARTICIPANTS

Seventeen adult patients with unilateral isolated rib fractures who were followed in the thoracic surgery department.

INTERVENTION: All patients received ultrasound-guided single-shot SPSIPB, with the ultrasound probe positioned in the sagittal plane just medial to the medial border of the scapula and in-plane needle advancement in a caudocranial direction. A total of 30 mL of 0.25% bupivacaine with epinephrine was injected between the serratus posterior superior muscle and the second rib. Rescue analgesia with intravenous tramadol (50 mg) was administered when the Numeric Rating Scale (NRS) score was ≥4.

MEASUREMENTS AND MAIN

RESULTS

Pain scores (NRS) were recorded before block application and at multiple time points up to 36 hours. Nine patients required no opioid consumption during follow-up, while five patients consumed 50 mg and three patients consumed 100 mg of tramadol. NRS scores decreased significantly after block application and remained low in most patients, with a tendency to increase at 36 hours. Dermatomal spread was predominantly between C5 and T8.

CONCLUSIONS

SPSIPB may provide effective and prolonged analgesia in patients with isolated rib fractures. Its relatively consistent dermatomal spread and opioid-sparing profile suggest that it may serve as a safe and practical component of multimodal analgesia strategies; however, larger prospective comparative studies are needed to confirm these findings.