Introduction
Opioid analgesia for thoracic surgery and trauma may be associated with adverse effects
including respiratory depression, cough suppression and diminished consciousness.
These adverse effects can be minimised using interfascial plane regional analgesia
such as the erector spinae and serratus anterior plane blocks (ESPB and SAPB) as first
described by Forero and colleagues and Blanco and colleagues, respectively.1,2 This
systematic review aims to evaluate the anatomical evidence underlying innervation
and dermatomal distribution of these two regional analgesic techniques. Additionally,
the pharmacokinetics of ESPB and SAPB were compared.
Methods
Google Scholar, DiscoverEd, and PubMed were searched using key words: ESPB, SAPB,
nerve block, local anaesthetic systemic toxicity, dermatomal spread, pharmacokinetics.
Results
The search yielded 39 papers investigating anatomical and pharmacokinetic evidence
of which 11 were identified as relevant (Table 1). Table 1 found as an attachment
Pharmacokinetic Results: The most commonly used local anaesthetic was bupivacaine
and the use of adjuvants was infrequent. As proposed by Luftig and colleagues,3 a
larger volume of a weaker concentration appears to reduce the chance of local anaesthetic
systemic toxicity. Anatomical spread is dependent upon the dose and site of injection.
Techniques can be easily taught and reproduced.
Discussion
The anatomical and pharmacokinetic evidence supports use of both techniques for thoracic
regional analgesia with ESPB spreading more caudally than SAPB. However, there is
anatomical variance between patients in the spread of each block. Pharmacokinetic
evidence supports the use of low-concentration, high-volume local anaesthetic for
optimal efficacy and limited toxicity.
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Copyright
© 2021 Published by Elsevier Inc.
