Serratus Anterior

by | Aug 23, 2021

Indications

  • Rib fractures
  • Thoracic lacerations or injuries

Contraindications

  • Infection overlying injection site
  • Allergy to local anesthetic

Equipment

  • 15-20cc of local anesthetic of choice diluted with 15-20cc of normal saline
  • 20-22G needle (or spinal needle)
  • Cleansing solution
  • Ultrasound with high-frequency linear transducer
  • Ultrasound transducer sterile cover

Preparation

Position

  1. Position the patient in lateral decubitus with the target side facing up
  2. Raise the ipsilateral arm or place behind the head

Ultrasound

Landmarks

Place the transducer in approximately the midaxillary line (marker facing the pectoralis)

Technique

  1. In-plane needle visualization
  2. Enter from posterior side
  3. Target the fascial plane superficial to the serratus muscle

Examples

Demonstration of in-plane approach to inject anesthetic in the fascial plane between the pectoralis minor (PM) and serratus anterior (SA) muscles. Fluid can be seen in the pleural space beneath serratus anterior

Source

  1. Highland Ultrasound
  2. The POCUS Atlas