Low-dose dexmetedomidine as adjuvant to serratus anterior plane block for chest trauma in critically ill patient: less is more, three cases.

Background Single-shot Serratus Anterior Plane Block (SAPB) with a minimal Dexmedetomidine (DEX) dose as part of multimodal analgesia for chest trauma in critically ill patient.
Case 1: 73-year-old man with sternum and left rib fractures, received SAPB+DEX six hours post-trauma, yielding substantial pain relief (NRS 9 to 3) for 72 hrs, and improved respiratory mechanics.
Case 2: 72-year-old woman with diaphragmatic lesion and rib fractures, underwent SAPB+DEX pre-weaning, was subjected to 65-hour non-invasive ventilation and then reintubated. SAPB aiding in identifying reasons of weaning failure due to diaphragmatic paralysis rather than pain.
Case 3: 45-year-old man with multiple rib fractures received bilateral SAPB+DEX, a catheter was positioned in the SAP plane. Single shot achieved 72-hour analgesia, catheter was removed as it remained unused.
Conclusion. This approach to SAPB is considered safe and efficient, even in polytrauma cases, for T3-T8 chest wall analgesia. First reported use of DEX (0,4mcg/kg) further extends analgesia to 72 hrs.