Ultrasound-Guided Serratus Anterior Plane Block for Acute Zoster Pain in an Immunocompromised Heart Transplant Patient in the Emergency Department

Richard J Gawel; Cesar Soto

doi:10.1016/j.jemermed.2025.02.004

Ultrasound-Guided Serratus Anterior Plane Block for Acute Zoster Pain in an Immunocompromised Heart Transplant Patient in the Emergency Department

J Emerg Med. 2025 Feb 8:S0736-4679(25)00025-3. doi: 10.1016/j.jemermed.2025.02.004. Online ahead of print.

Authors

Richard J Gawel¹, Cesar Soto²

Affiliations

¹ Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Richard.Gawel@pennmedicine.upenn.edu.
² Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

PMID: 40355299
DOI: 10.1016/j.jemermed.2025.02.004

Abstract

Background: Zoster rashes are painful and may be difficult to manage with conventional oral, topical, and intravenous analgesics. Ultrasound-guided regional nerve blocks may have a role as part of a multimodal analgesia strategy for managing acute pain in these patients.

Case report: We report the case of a 54-year-old immunocompromised man with a remote history of heart transplant who presented with an acute multi-dermatomal thoracic zoster rash and was awaiting admission for antiviral therapy and close monitoring. After negligible pain relief from multiple doses of intravenous opioids, he underwent an uncomplicated serratus anterior plane block which considerably improved his pain and decreased his opioid utilization for the duration of his hospitalization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The ultrasound-guided serratus anterior plane block (SAPB) may be a safe and effective analgesic strategy for managing refractory thoracic zoster pain in immunocompromised patients in the emergency department.

Keywords: Serratus anterior plane block; Ultrasound; Ultrasound-guided regional anesthesia; Zoster.