The aim of this study was to compare the relative efficacy of ultrasound-guided serratus
anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve
block (ICNB) for the management of post-thoracotomy pain in pediatric cardiac surgery.
A prospective, randomized, single-blind, comparative study.
Single-institution tertiary referral cardiac center.
The study comprised 108 children with congenital heart disease requiring surgery through
Children were allocated randomly to 1 of the 3 groups: SAPB, Pecs II, or ICNB. All
participants received 3 mg/kg of 0.2% ropivacaine for ultrasound-guided block after
induction of anesthesia. Postoperatively, intravenous paracetamol was used for multimodal
and fentanyl was used for rescue analgesia.
Measurements and Main Results
A modified objective pain score (MOPS) was evaluated at 1, 2, 4, 6, 8, 10, and 12
hours post-extubation. The early mean MOPS at 1, 2, and 4 hours was similar in the
3 groups. The late mean MOPS was significantly lower in the SAPB group compared with
that of the ICNB group (p < 0.001). The Pecs II group also had a lower MOPS compared
with the ICNB group at 6, 8, and 10 hours (p < 0.001), but the MOPS was comparable
at hour 12 (p = 0.301). The requirement for rescue fentanyl was significantly higher
in ICNB group in contrast to the SAPB and Pecs II groups.
SAPB and Pecs II fascial plane blocks are equally efficacious in post-thoracotomy
pain management compared with ICNB, but they have the additional benefit of being
longer lasting and are as easily performed as the traditional ICNB.