Serratus Anterior Plane Block

The serratus anterior plane block (SAPB) is an ultrasound-guided regional anaesthesia technique that can transform rib fracture care. By targeting the lateral cutaneous branches of the intercostal nerves, it provides analgesia to most of the ipsilateral hemithorax and can rapidly shift patients from “can’t breathe” to “can cough”, with a much higher proportion achieving pain scores below the “moderate” range.

Together with Dr Daniel Gaetani, Dr Timothy Manion and Prof Kate Curtis, we’ve put together a FOAMed, evidence-based education package on SAPB for emergency clinicians. It’s designed so local experts can focus on teaching and implementation, without having to reinvent the wheel.

The package walks you through a simple seven-step pathway – Identify, Consent, Location, Equipment, Sonoanatomy, Procedure and Post-procedure care – and covers everything from indications, contraindications and local anaesthetic dosing, to ultrasound anatomy, video walkthroughs, and a practical training and credentialling framework.

This guide assumes you’re already comfortable with the basics of plane blocks (aseptic technique, risk management, monitoring after high-dose local anaesthetic, ultrasound use) and shows you how to apply those skills specifically to the serratus anterior plane block in the ED.

References

FOAMed

• Miers J, Partyka C. Procedure: Serratus Anterior Block. LITFL
• Partyka C, Gaetani D, Manion T, Curtis K. Serratus Anterior Plane Block. LITFL

Journals

• Partyka C, Asha S, Berry M, Ferguson I, Burns B, Tsacalos K, Gaetani D, Oliver M, Luscombe G, Delaney A, Curtis K. Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. JAMA Surg. 2024 Jul 1;159(7):810-817. 
• Partyka C, Asha S, Berry M, Ferguson I, Burns B, Tsacalos K, Gaetani D, Oliver M, Luscombe G, Delaney A, Curtis K. Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. JAMA Surg. 2024 Jul 1;159(7):810-817.
• Partyka C, Miller M, Burgess S, Drury K, Delaney A, Curtis K. Anatomical Location of Rib Fractures and Associated Analgesic Benefits Achieved From Serratus Anterior Plane Blocks: A Spatial Point Pattern Analysis. Anesth Analg. 2025 Jan 1;140(1):231-234
• Curtis K, Asha SE, Unsworth A, Lam M, Goldsmith H, Langcake M, Dwyer D. ChIP: An early activation protocol for isolated blunt chest injury improves outcomes, a retrospective cohort study. Australas Emerg Nurs J. 2016 Aug;19(3):127-32
• Harrington C, Bliss J, Lam L, Partyka C. Serratus Anterior Plane Block for Clinically Suspected Rib Fractures in Prehospital and Retrieval Medicine. Prehosp Emerg Care. 2024;28(1):30-35