View source for Nerve block: serratus anterior

==Overview==
*Injection of local anesthetic around the thoracic intercostal nerves to provide regional anesthesia to the anterolateral chest wall

==Indications==
*Rib fractures <ref>Southgate SJ, Herbst MK. Ultrasound Guided Serratus Anterior Blocks. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538476/</ref>
*Rib contusions

==Contraindications==
*Overlying soft tissue infection
*Allergy to local anesthetic

==Equipment Needed==
*Ultrasound (linear transducer) w/ sterile probe cover
*Sterile gloves
*Chlorhexidine or betadine solution
*1% lidocaine with epinephrine in syringe with 27-gauge needle (for skin wheel)
*0.5% or 0.25% bupivacaine in 30 ml syringe. 
*18 gauge blunt needle
*22-25 gauge peripheral nerve block needle with extension tubing
**Alternatively, 22g spinal needle with IV extension tubing

==Procedure== 
*Position patient in supine or lateral decubitus position (injured side up)<ref>https://templepocus.com/regional-anesthesia/b28jyz9rhr3n4b3chbdhhs7z62s7pb</ref>
*Sterilize skin w/ antiseptic solution
*Inject wheal of lidocaine into injection site
*Place ultrasound probe lateral to the nipple in transverse orientation
*Find the serratus anterior muscle overlying the ribs in the lateral chest wall
*Using the in-plane technique, advance needle with dominant hand
*Identify the pleural line prior to inserting the needle
*Advance the needle toward the rib (you will feel a pop once through the fascia)
*Connect tubing to needle and syringe. 
*Push 2-3 cc to confirm placement between the serratus anterior and latissimus dorsi. The two should separate freely.
*Inject the remaining anesthetic

==Complications==
*Nerve injury
*Vascular injury
*Rebound pain

==See Also==
*[[Nerve blocks (main)]]
*[[Local anesthetic systemic toxicity]]

==External Links==

===Videos===
{{#widget:YouTube|id=3Qlo5MIdtEc}}

==References==
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[[Category:Procedures]]