Low-dose dexmetedomidine as adjuvant to serratus anterior plane block for chest trauma in critically ill patient: less is more, three cases.
Francesca De Sanctis1, Ezio Amorizzo2, Gian Marco petroni1, Luciano Giacomino1, Giuseppe Fratini1, Bruno Coccetti3, Rita Commissari1, Pierfrancesco Fusco41Department of Anesthesia, Critical Care and Pain Medicine, Az. Osp. S. Maria Terni (Italy)2Pain Unit, San Paolo Hospital Civitavecchia, Italy
3Department of Anesthesia, Critical Care and Pain Medicine, S. Camillo de Lellis Rieti, Italy
4Departmen of Intensive Care Unit, Department of Anesthesiology, S. Filippo e Nicola Hospital, Avezzano, L'Aquila, Italy.
Background Single-shot Serratus Anterior Plane Block (SAPB) with a minimal Dexmedetomidine (DEX) dose as part of multimodal analgesia for chest trauma in critically ill patient.
Case 1: 73-year-old man with sternum and left rib fractures, received SAPB+DEX six hours post-trauma, yielding substantial pain relief (NRS 9 to 3) for 72 hrs, and improved respiratory mechanics.
Case 2: 72-year-old woman with diaphragmatic lesion and rib fractures, underwent SAPB+DEX pre-weaning, was subjected to 65-hour non-invasive ventilation and then reintubated. SAPB aiding in identifying reasons of weaning failure due to diaphragmatic paralysis rather than pain.
Case 3: 45-year-old man with multiple rib fractures received bilateral SAPB+DEX, a catheter was positioned in the SAP plane. Single shot achieved 72-hour analgesia, catheter was removed as it remained unused.
Conclusion. This approach to SAPB is considered safe and efficient, even in polytrauma cases, for T3-T8 chest wall analgesia. First reported use of DEX (0,4mcg/kg) further extends analgesia to 72 hrs.
Keywords: Rib fractures, Polytraumatized, ICU patient, Serratus Anterior Plane Block, Multimodal analgesia, Weaning, Loco-regional anesthesia, Chest trauma.
Manuscript Language: English