الفهرس 
Anatomical considerations:
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Abstract
Summary and conclusion Rib fractures are the most common of all chest injuries and occur in up to 80% of patients with blunt chest trauma. Pain associated with rib movement reduces the tidal volume and predisposes to significant atelectasis. This can further lead to retention of pulmonary secretions and pneumonia. The cornerstone of the management of patients with multiple rib fractures includes aggressive management of chest wall pain as this will attenuate the development of pulmonary complications. TPVB has been used for pain relief of multiple rib fractures through injecting a local anesthetic agent close to where the spinal nerves exit the ntervertebral foramina, it can provide high-quality ipsilateral, segmental, somatic, and sympathetic nerve blockade. The SAP block is a novel, safe regional analgesic technique first described by blanco for breast surgeries. It can provide analgesia to the lateral branches of the intercostal nerves T2–T9 through the injection of local anesthetic either superficial or deep to serratus anterior muscle. Our prospective randomized study aimed to compare the analgesic efficacy of ultrasound guided continuous SAP block and ultrasound guided continuous TPVB in patients with multiple traumatic rib fractures. The Primary outcome was pain scores in the 4 days after the block. Secondary outcomes were the total consumption of morphine, changes of pulmonary functions, length of ICU stay and hospital stay and the incidence of respiratory complications and mechanical ventilation. This study was carried out in ICU at Tanta University Hospitals from December 2018 to June 2020 on 70 patients of either sex aged between 22- 65 years with unilateral multiple traumatic fracture ribs 3 fractured ribs).