# Bilateral Serratus Plane Block in a Critically Ill, Mechanically Ventilated Patient with Multiple Rib Fractures Due to Severe Thoracic Trauma: Case Report and Literature Review

## TL;DR

This case report and literature review show that a bilateral Serratus Plane Block can effectively manage pain in critically ill patients with multiple rib fractures, helping them wean off mechanical ventilation.

## Contribution

The paper presents a novel case of bilateral SAPB use in a critically ill patient and reviews its limited application in similar clinical scenarios.

## Key findings

- Bilateral SAPB provided immediate pain relief and enabled weaning from mechanical ventilation in a polytrauma patient.
- Literature review found only 3 cases of bilateral SAPB among 197 total cases, highlighting its underutilization in critical care.
- Published studies showed variability in SAPB protocols and outcomes, with only two addressing its role in mechanical ventilation weaning.

## Abstract

Background/Objectives: Effective pain management in polytrauma patients with rib fractures is essential, particularly in the critical care setting. While epidural analgesia is considered the gold standard, it is not always feasible, necessitating alternative locoregional approaches. We present the case of a polytrauma patient with multiple, bilateral rib fractures and severe chest pain that hindered weaning from mechanical ventilation. A bilateral Serratus Anterior Plane Block (SAPB) was performed, with catheters placed for continuous administration of local anesthetics. Pain relief was immediate, enabling a rapid weaning from mechanical ventilation, safe extubation, and subsequent discharge to rehabilitation. A review of the literature on this technique in critically ill patients with thoracic trauma and multiple rib fractures is also presented. Methods: We conducted a literature search up to November 2024, identifying studies evaluating the use of SAPB in critically ill patients with chest trauma and rib fractures. Results: Eight studies were identified, including a total of 197 cases, of which only 3 involved a bilateral SAPB. Studies and published case reports demonstrated significant variability in analgesic protocols and reported outcomes. Notably, only two papers addressed specifically its role in facilitating weaning from mechanical ventilation. Conclusions: Pain control is fundamental in managing severe chest trauma. This case and the reviewed literature suggest that the SAPB is a promising option when epidural analgesia is contraindicated or impractical. However, further studies are needed to define its place in clinical practice and optimize its use in critically ill patients.