Objective
Thoracotomy is one of the most painful surgical procedures. The aim of this study
was to assess the efficacy and safety of ultrasound-guided serratus anterior plane
block (SAPB) compared with thoracic epidural analgesia (TEA) for controlling acute
thoracotomy pain.
Design
A prospective, randomized, observer–blinded, controlled study.
Setting
The study was performed as a single-institution study in the National Cancer Institute,
Cairo University, Egypt.
Participants
All participants were cancer patients scheduled for thoracotomy.
Interventions
This study was conducted from February to December 2015. Forty patients scheduled
for thoracotomy under general anesthesia were allocated randomly into 1 of 2 groups
with 20 patients each. SAPB was performed before extubation with an injection of 30
mL of 0.25% levobupivacaine followed by 5 mL/hour of 0.125% levobupivacaine. In the
TEA group, thoracic epidural catheters were inserted preoperatively to be activated
before extubation using a lower dose regimen to the SAPB group. Heart rate, mean arterial
pressure, and the visual analog pain score (VAS) measurements were recorded for 24
hours. Rescue analgesia using intravenous morphine, 0.1 mL/kg, was administered if
the VAS was >3.
Measurements and Main Results
Compared with preoperative values, the mean arterial pressure in the SAPB group did
not change significantly (p = 0.181), whereas it decreased significantly (p = 0.006)
in the TEA group. VAS scores and the total dose of morphine consumed were comparable
in the 2 groups.
Conclusions
SAPB appeared to be a safe and effective alternative for postoperative analgesia after
thoracotomy.
Key Words
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References
- Pain relief after thoracotomy.Br J Anaesth. 2007; 98 (author reply 844-845): 844
- Impact of acute pain and its management for thoracic surgical patients.Thorac Surg Clin. 2005; 15: 105-121
- Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy.Eur J Cardiothorac Surg. 2002; 21: 298-301
- Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia.Anesthesiology. 2002; 97: 1234-1244
- Chronic pain as an outcome of surgery. A review of predictive factors.Anesthesiology. 2000; 93: 1123-1133
- The effects of three different analgesia techniques on long-term postthoracotomy pain.Anesth Analg. 2002; 94 (table of contents): 11-15
- Intrapleural blocks for chest wall surgery.Anaesthesia. 2014; 69: 85-86
- A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy—a systematic review and meta-analysis of randomized trials.Br J Anaesth. 2006; 96: 418-426
- A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia.Anesth Analg. 2008; 107: 1026-1040
- Efficacy and safety of paravertebral blocks in breast surgery: A meta-analysis of randomized controlled trials.Br J Anaesth. 2010; 105: 842-852
- Intercostal nerve block for lumpectomy: Superior postoperative pain relief with bupivacaine.J Clin Anesth. 1994; 6: 47-51
- Interpleural block - part 1.Anaesthesia. 2007; 62: 1039-1049
- Preventing and treating pain after thoracic surgery.Anesthesiology. 2006; 104: 594-600
- Incidence of neurologic complications related to thoracic epidural catheterization.Anesthesiology. 1997; 86: 55-63
- Thoracic paravertebral block.Anesthesiology. 2001; 95: 771-780
- Serratus plane block: A novel ultrasound-guided thoracic wall nerve block.Anaesthesia. 2013; 68: 1107-1113
- Thoracic epidural anesthesia: Asleep at the wheal?.Anesth Analg. 2004; 99: 578-579
- Serratus plane block: The regional analgesia technique for thoracoscopy?.Anaesthesia. 2015; 70: 1329-1330
- Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery.Egypt J Anaesth. 2014; 30: 129-135
- Serratus plane block: Do we need to learn another technique for thoracic wall blockade?.Anaesthesia. 2013; 68: 1103-1106
- Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks.Anaesthesia. 2011; 66: 1023-1030
- An anatomical evaluation of the serratus anterior plane block.Anaesthesia. 2016; 71: 1064-1069
- Serratus anterior plane block: A new analgesic technique for post-thoracotomy pain.Pain Physician. 2015; 18: E421-424
- Serratus anterior plane block for multiple rib fractures.Pain Physician. 2014; 17: E651-653
- Serratus plane block for shoulder surgery.Anaesthesia. 2014; 69: 395-396
- Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery.Rev Esp Anestesiol Reanim. 2013; 60: 365-370
- [Serratus-intercostal plane block for breast surgery].Masui. 2015; 64: 610-614
- Serratus anterior plane block for breast surgery in a morbidly obese patient.J Clin Anesth. 2015; 33: 500-501
- Ultrasound-guided serratus anterior plane block in breast reconstruction surgery.A A Case Rep. 2016; 6: 280-282
Article info
Publication history
Published online: December 06, 2016
Identification
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© 2016 Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Serratus Anterior Plane Block Versus Thoracic Epidural Analgesia for Post-Thoracotomy Pain ReliefJournal of Cardiothoracic and Vascular AnesthesiaVol. 32Issue 6
- PreviewWe read with great interest the description by Khalil and colleagues of the serratus anterior plane block as an alternative to thoracic epidural analgesia for post-thoracotomy pain.1 This block holds great promise for this incision given the adverse effects of epidural block2 and technical difficulties of ultrasound-guided paravertebral block.3
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