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Case Report of Serratus Plane Catheter for Pain Management in a Patient With Multiple Rib Fractures and an Inferior
Peter Fu1, Paul D Weyker, Christopher A J Webb
1From the *Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York; †Department of Anesthesiology, Divisions of Pain Medicine and Critical Care, Columbia University Medical Center, New York, New York; and ‡Staff Anesthesiologist at Kaiser Permanente in San Francisco, California; Clinical Instructor in Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, California.
Abstract:
We placed a superficial serratus anterior plane catheter in an elderly woman with dementia and elevated clotting times who presented with multiple rib fractures after a mechanical fall. She was not a surgical candidate, and treatment consisted of conservative management with physical therapy and pain control. She was not a candidate for a patient-controlled analgesia regimen because of her dementia. Given her elevated international normalized ratio, thoracic epidural and paravertebral analgesia was also contraindicated. We placed an ultrasound-guided serratus anterior plane catheter, allowing titratable continuous infusion in a trauma patient, resulting in excellent analgesia without adverse effects.
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Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...

