Continuous Serratus Posterior Superior Intercostal Plane Block: A Novel Approach for Analgesia in Rib Fractures

Background: Rib fractures are associated with severe pain, respiratory dysfunction, and increased morbidity. Adequate analgesia is essential to prevent pulmonary complications (1,2). The serratus posterior superior intercostal plane block (SPSIPB) has recently been described as a novel ultrasound-guided regional block that provides thoracic wall analgesia (3). Case presentation: We report five adult patients (aged 29–69 years) with multiple unilateral rib fractures who received continuous SPSIPB for postoperative pain management. Under ultrasound guidance, a catheter was inserted between the serratus posterior superior and intercostal muscles at the T2–T4 level (4). Following an initial bolus of 30 mL 0.25% bupivacaine with epinephrine (1:200,000), continuous infusions (10 mL 0.25% bupivacaine every 12 hours) were maintained for 2–4 days. All patients demonstrated a reduction in numeric rating scale (NRS) pain scores from 5–9 at rest to ≤3 within 30 minutes post-block. No complications or local anesthetic systemic toxicity were observed (5). Early mobilization and improved respiratory parameters were achieved in all cases. The ultrasound-guided needle and catheter placement are demonstrated in Figure 1. Conclusions: Continuous SPSIPB appears to be an effective and safe regional analgesic technique for managing pain in patients with multiple rib fractures. Larger studies are warranted to confirm its efficacy and define optimal dosing strategies.