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Because altered sensorium can make systemic opioids risky for neurological assessment, an ultrasound-guided right serratus anterior plane block was performed, followed by a left-sided block. Pain scores dropped from 8/10 to 4/10 and then to 2/10, sustained for 6 hours without additional analgesia, enabling ongoing neurological monitoring and stabilization in the emergency department.",{"@graph":69,"@context":114},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/serratus-anterior-plane-block-for-managing-pain-in-a-case-of-bilateral-erosive-carcinoma-of-breast/460406/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/serratus-anterior-plane-block-for-managing-pain-in-a-case-of-bilateral-erosive-carcinoma-of-breast/460406.png","ImageObject",300,407,{"name":92,"@type":93},"CatatanPagi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108],{"name":109,"@type":110,"acceptedAnswer":111},"What broader implication does the letter suggest for emergency practice?","Question",{"text":112,"@type":113},"It argues for broader emergency use of bilateral SAP blocks, particularly when preserved sensorium is needed, because the blocks provided rapid, sustained analgesia without systemic opioids or sedatives while supporting neurological assessment and stabilization.","Answer","https://schema.org",{"og:url":83,"og:type":116,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":118,"canonical":83},"index,follow",{"doc_id":120,"site_id":62},460406,1790758402,{"code":4,"msg":5,"data":123},{"doc_id":120,"user_id":124,"nickname":92,"user_avatar":125,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":126,"file_id":127,"file_url":128,"file_type":129,"file_size":130,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":131,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":132,"faqs":133,"seo_title":134,"seo_description":67,"update_tm":121,"read_time":24,"preview_page_count":4},962090894170,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","| Letters to Editor |\n| --- |\n|  |\n\nSerratus Anterior Plane Block for Managing Pain in a Case of Bilateral Erosive Carcinoma of Breast  \nDear Editor,  \nManaging severe pain in the emergency department presents a unique challenge, especially inpatients with altered sensorium where systemic analgesics such as opioids may compromise neurological assessment. Regional anesthesia techniques offer a valuable alternative by providing effective analgesia without sedation.  \nThe serratus anterior plane (SAP) block is a regional anesthesia technique that has shown efficacy in controlling pain associated with thoracic and breast surgeries, rib fractures, and postmastectomy pain. [1] Its use in the emergency setting is gaining traction due to its simplicity, safety profile, and ability to provide significant analgesia for chest wall pain.  \nWe report the rare and complex case of a 52‑year‑old woman presenting with septic shock and extensive, erosive carcinoma of the right breast, causing complete destruction of the chest wall, and exposing the lung [Figure 1a] . On arrival, she was hypotensive, tachycardic, and febrile, with a Glasgow Coma Scale (GCS) of E2V4M5 . Her Faces Pain Scale-Revised (FPS‑R) pain score was 8/10 .  \nIn order to avoid sedation and preserve neurological monitoring, an ultrasound-guided right-sided SAP block was administered [Figure 1b and c], reducing the pain score to 4/10 . A left-sided SAP block further reduced it to 2/10 . This relief was sustained for 6 h without additional analgesia.  \nBilateral carcinoma of the breast is uncommon[2] and such an advanced erosive presentation with exposed lung is exceptionally rare. While surgical resection and chest wall reconstruction may be indicated,[3] emergency pain control remains a top priority. The SAP block has been used safely  \nin radical mastectomy and postmastectomy pain[4] and more recently in rib fracture pain management.[5]  \nThis case demonstrates the effective use of bilateral SAP blocks as a primary modality for pain management in a critically ill patient with advanced breast carcinoma and septic shock. The SAP block provided rapid, sustained analgesia without the need for systemic opioids or sedatives, allowing for ongoing neurological assessment and stabilization in the emergency department. We advocate for broader emergency use of SAP blocks, particularly in cases requiring preserved sensorium.  \nSincerely,  \nResearch quality and ethics statement  \nThe authors followed applicable EQUATOR Network ([https://](https://)[ ](https://)[www.equator-network.org/](www.equator-network.org/)) guidelines, notably the CARE guideline, during the conduct of this report.  \nDeclaration of patient consent  \nThe authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.  \nResearch quality and ethics statement  \nThe authors followed applicable EQUATOR Network ([https://](https://)[ ](https://)[www.equator-network.org/](www.equator-network.org/)) guidelines, notably the CARE guideline, during the conduct of this report.  \nFinancial support and sponsorship  \nNil.  \nFigure 1: (a) Erosive and ulcerated carcinoma of the right breast with complete chest wall and rib destruction, exposing the pleura. (b) Sonoanatomy: The latissimus dorsi and serratus anterior muscles. (c) Needle approaching the fascia and the splitting of fascia as anaesthetic is injected  \n© 2025 Journal of Emergencies, Trauma, and Shock | Published by Wolters Kluwer-Medknow 199   \nLetters to Editor  \nConflicts of interest  \nThere are no conflicts of interest.  \nJoshua Daniel Birru, Varsha Shinde  \nDepartment of Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (D","cbCaiszWvTwDfY3O","https://ap.wps.com/l/cbCaiszWvTwDfY3O","pdf",606837,"English","# Letters to Editor\n## Case report and analgesia outcome\n## Ethics, consent, and disclosures\n## Figures and references","[{\"question\":\"What broader implication does the letter suggest for emergency practice?\",\"answer\":\"It argues for broader emergency use of bilateral SAP blocks, particularly when preserved sensorium is needed, because the blocks provided rapid, sustained analgesia without systemic opioids or sedatives while supporting neurological assessment and stabilization.\"}]","Serratus Anterior Plane Block for Managing Pain in a Case of Bilateral Erosive Carcinoma of Breast | PDF"]