Anatomical study of the serratus anterior space block in cadaver
QIN Zhi-xiang, LI Chun-yu, XING Bai-chun, NIU Xiang-lan, HU Biao-biao, DU Xing-chen, CHEN Wei-ying, TANG Xing-ming, GUO Xing, JIA Jin-tai
Chinese Journal of Clinical Anatomy ›› 2017, Vol. 35 ›› Issue (5) : 490-493.
Anatomical study of the serratus anterior space block in cadaver
Objective This study was conducted to investigate extent of spread of injecting methylene blue and nerve involvement in serratus anterior space. Method The ultrasound scans were performed with a GE(Venue 40) 9~13 MHz linear array transducer. Cadavers were placed in the prone position. Ribs were counted by ultrasound to locate the space between the 4th and 5th rib in the midaxillary line, and from there to the serratus anterior muscle. Under real-time ultrasound guidance, a needle was inserted within the serratus plane between the 4th and 5th rib in the midaxillary line by the Blanco method for administration of 0.4 ml/kg methylene blue. There were a total of 8 injections. After injection of 10 min, layers were separated into the anterior serratus muscle space. The extent of dye spread was measured in the serratus space, and the nerves stained were documented. Results Afterpectoralis major and minor muscles were removed respectively, structuresstained by the dye within serratus space wereidentified, including lateral cutaneous branches of 2~6 intercostal nerves, long thoracic nerve and thoracodorsal nerve stained. Spread of dye within eight serratus planes was identified by expressed in medians(P25, P75). They are 11.35(10.45,12.15)cm in the anterior axillary line,12.6(12.12,13.15)cm in the midaxillary line, 11.1(10.70,12.05)cm in the posterior axillary line, and 9.8(9.12,10.65) in the nipple line. Cephalad spread of contrast was noted in 2nd and 3rd intercostal space (75% and 25%) at anterior axillary line,(87.5% and 12.5%) at the midaxillary line, and (87.5% and 12.5%)at the anterior axillary line respectively. Conclusion This study describes that the injection spread in serratus space can be determined with the help to provide analgesia to the anterolateral chest wall.
Serratus anterior space / Methylene blue / Anatomical study / Cadaver
[1] Blanco R, Parras T, McDonnell JG, et al. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block[J]. Anaesthesia, 2013, 68(11): 1107-1113.
[2] Ohgoshi Y, Yokozuka M, Terajima K. Serratus-intercostal plane block for breast surgery[J]. Masui, 2015, 64(6): 610-614.
[3] Madabushi R, Tewari S, Gautam SK, et al. Serratus anterior plane block: a new analgesic technique for post-thoracotomy pain[J]. Pain Physician, 2015, 18(3): E421-4214.
[4] Kunhabdulla NP, Agarwal A, Gaur A, et al. Serratus anterior plane block for multiple rib fractures[J].Pain Physician, 2014, 17(4): E553-555.
[5] May L, Hillermann C, Patil S. Rib fracture management[J]. BJA Education, 2016, 16(1): 26-32.
[6] Womack J, Varma MK. Serratus plane block for shoulder surgery[J]. Anaesthesia, 2014, 69(4): 395-396.
[7] 罗益竹, 张奇龄, 朱光琼. 前锯肌的应用解剖学研究[J]. 四川解剖学杂志, 2016, 24(1):12-15.
[8] 韩震, 钟世镇, 孙博, 等. 前锯肌及其神经支配的解剖学研究[J]. 中国临床解剖学杂志, 1986, 4(3):158-160.
[9] 李翔, 刘丰春. 乳头、乳晕区神经分布的应用解剖特点[J]. 中国组织工程研究与临床康复, 2007, 11(4): 795-797.
[10] 郑老须,郑韬. 乳头与乳晕神经支配的临床解剖研究[J]. 河南科技大学学报( 医学版) , 2012, 30 (2 ):89-90.
[11] 何桂丽, 翟立杰, 曹忠胜. 麻醉方式的临床决策[J].医学与哲学, 2006, 27(20):6-8.
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