Ultrasound-Guided Serratus Anterior Plane Block Versus Thoracic Epidural Analgesia for Thoracotomy Pain

Published:December 06, 2016DOI:


      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.


      A prospective, randomized, observer–blinded, controlled study.


      The study was performed as a single-institution study in the National Cancer Institute, Cairo University, Egypt.


      All participants were cancer patients scheduled for thoracotomy.


      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.


      SAPB appeared to be a safe and effective alternative for postoperative analgesia after thoracotomy.

      Key Words

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        • McGovern I.
        • Walker C.
        • Cox F.
        Pain relief after thoracotomy.
        Br J Anaesth. 2007; 98 (author reply 844-845): 844
        • Ochroch E.A.
        • Gottschalk A.
        Impact of acute pain and its management for thoracic surgical patients.
        Thorac Surg Clin. 2005; 15: 105-121
        • Rogers M.L.
        • Henderson L.
        • Mahajan R.P.
        • et al.
        Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy.
        Eur J Cardiothorac Surg. 2002; 21: 298-301
        • Ochroch E.A.
        • Gottschalk A.
        • Augostides J.
        • et al.
        Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia.
        Anesthesiology. 2002; 97: 1234-1244
        • Perkins F.M.
        • Kehlet H.
        Chronic pain as an outcome of surgery. A review of predictive factors.
        Anesthesiology. 2000; 93: 1123-1133
        • Sentürk M.
        • Ozcan P.E.
        • Talu G.K.
        • et al.
        The effects of three different analgesia techniques on long-term postthoracotomy pain.
        Anesth Analg. 2002; 94 (table of contents): 11-15
        • Morris C.J.
        • Bunsell R.
        Intrapleural blocks for chest wall surgery.
        Anaesthesia. 2014; 69: 85-86
        • Davies R.G.
        • Myles P.S.
        • Graham J.M.
        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
        • Joshi G.P.
        • Bonnet F.
        • Shah R.
        • et al.
        A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia.
        Anesth Analg. 2008; 107: 1026-1040
        • Schnabel A.
        • Reichl S.U.
        • Kranke P.
        • et al.
        Efficacy and safety of paravertebral blocks in breast surgery: A meta-analysis of randomized controlled trials.
        Br J Anaesth. 2010; 105: 842-852
        • Atanassoff P.G.
        • Alon E.
        • Weiss B.M.
        Intercostal nerve block for lumpectomy: Superior postoperative pain relief with bupivacaine.
        J Clin Anesth. 1994; 6: 47-51
        • Dravid R.M.
        • Paul R.E.
        Interpleural block - part 1.
        Anaesthesia. 2007; 62: 1039-1049
        • Gottschalk A.
        • Cohen S.P.
        • Yang S.
        • et al.
        Preventing and treating pain after thoracic surgery.
        Anesthesiology. 2006; 104: 594-600
        • Giebler R.M.
        • Scherer R.U.
        • Peters J.
        Incidence of neurologic complications related to thoracic epidural catheterization.
        Anesthesiology. 1997; 86: 55-63
        • Karmakar M.K.
        Thoracic paravertebral block.
        Anesthesiology. 2001; 95: 771-780
        • Blanco R.
        • Parras T.
        • McDonnell J.G.
        • et al.
        Serratus plane block: A novel ultrasound-guided thoracic wall nerve block.
        Anaesthesia. 2013; 68: 1107-1113
        • Drasner K.
        Thoracic epidural anesthesia: Asleep at the wheal?.
        Anesth Analg. 2004; 99: 578-579
        • Broseta A.M.
        • Errando C.
        • De Andrés J.
        • et al.
        Serratus plane block: The regional analgesia technique for thoracoscopy?.
        Anaesthesia. 2015; 70: 1329-1330
        • Wahba S.S.
        • Kamal S.M.
        Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery.
        Egypt J Anaesth. 2014; 30: 129-135
        • Tighe S.Q.M.
        • Karmakar M.K.
        Serratus plane block: Do we need to learn another technique for thoracic wall blockade?.
        Anaesthesia. 2013; 68: 1103-1106
        • Carney J.
        • Finnerty O.
        • Rauf J.
        • et al.
        Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks.
        Anaesthesia. 2011; 66: 1023-1030
        • Mayes J.
        • Davison E.
        • Panahi P.
        • et al.
        An anatomical evaluation of the serratus anterior plane block.
        Anaesthesia. 2016; 71: 1064-1069
        • Madabushi R.
        • Tewari S.
        • Gautam S.K.
        • et al.
        Serratus anterior plane block: A new analgesic technique for post-thoracotomy pain.
        Pain Physician. 2015; 18: E421-424
        • Kunhabdulla N.P.
        • Agarwal A.
        • Gaur A.
        • et al.
        Serratus anterior plane block for multiple rib fractures.
        Pain Physician. 2014; 17: E651-653
        • Womack J.
        • Varma M.K.
        Serratus plane block for shoulder surgery.
        Anaesthesia. 2014; 69: 395-396
        • Diéguez G.P.
        • Fajardo P.M.
        • López Á.S.
        • et al.
        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
        • Ohgoshi Y.
        • Yokozuka M.
        • Terajima K.
        [Serratus-intercostal plane block for breast surgery].
        Masui. 2015; 64: 610-614
        • Bhoi D.
        • Pushparajan H.K.
        • Talawar P.
        • et al.
        Serratus anterior plane block for breast surgery in a morbidly obese patient.
        J Clin Anesth. 2015; 33: 500-501
        • Khemka R.
        • Chakraborty A.
        • Ahmed R.
        • et al.
        Ultrasound-guided serratus anterior plane block in breast reconstruction surgery.
        A A Case Rep. 2016; 6: 280-282

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