Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery - a randomized trial

Arora, Saurabh; Ovung, Ronithung; Bharti, Neerja; Yaddanapudi, Sandhya; Singh, Gurpreet

doi:10.1016/j.bjane.2021.09.017

Cited by 15 publications

(17 citation statements)

References 25 publications

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“…Alternatives such as thoracic epidural analgesia and paravertebral block are available for pain management in patients undergoing breast surgery. [ 21 , 22 ] However, these blocks lead to hemodynamic changes such as hypotension and bradycardia caused by sympathetic blockade. [ 23 ] SAPB is a peripheral block that does not cause a sympathetic blockade.…”

Section: Discussionmentioning

confidence: 99%

The effects of ultrasound-guided serratus anterior plane block on intraoperative opioid consumption and hemodynamic stability during breast surgery: A randomized controlled study

et al. 2022

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Aim: To determine effect of ultrasound-guided serratus anterior plane block (SAPB) on intraoperative opioid consumption in patients undergoing oncoplastic breast surgery under general anesthesia. Methods: This study was conducted as a prospective, randomized controlled trial. Forty-four patients enrolled, aged 18 to 75 years with American Society of Anesthesiologists physical status I to III, undergoing elective oncoplastic breast surgery. Patients were randomly allocated to receive SAPB with 20 mL of 0.25% bupivacaine + general anesthesia (group SAPB) or only general anesthesia (group control). The primary outcome was assessing the effect of SAPB on intraoperative remifentanil consumption. Patients were assessed for emergence time, hemodynamic parameters, doses of rescue drugs used to control hemodynamic parameters, and duration of stay in the recovery room. Results: Preoperative SAPB with 0.25% bupivacaine reduced intraoperative opioid consumption (851.2 ± 423.5 vs 1409.7 ± 756.1 µg, P = .019). Emergence time was significantly shorter in group SAPB (6.19 ± 1.90 minutes) compared to group control (9.50 ± 2.39 minutes; P < .001). There were no significant differences in the doses of rescue drugs used for systolic blood pressure and heart rate between the groups. Conclusions: Preoperative SAPB with bupivacaine reduced intraoperative opioid consumption and shortened emergence time and duration of stay in the recovery unit, and hemodynamic stability was maintained without block-related complications.

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Section: Discussionmentioning

confidence: 99%

The effects of ultrasound-guided serratus anterior plane block on intraoperative opioid consumption and hemodynamic stability during breast surgery: A randomized controlled study

et al. 2022

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“…15 Suman Arora showed that the duration of SAPB guided block was significantly longer than that of TPVB ( P <0.001), which is consistent with the results of this study. 16 Kulhari et al found that the pain level of patients after ultrasound-guided thoracic nerve (PECS II) block was significantly better than that of patients with thoracic paravertebral block (TPVB). 17 The reason may be related to the pharmacological effect of the anesthesia method of thoracic nerve block.…”

Section: Discussionmentioning

confidence: 99%

Comparison of ultrasound-guided serratus anterior plane block and thoracic paravertebral block in postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery

Cai¹,

Xie²,

Xu³

et al. 2022

Pak J Med Sci

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Objective: To compare the effects of ultrasound-guided serratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) on postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery. Methods: This is a retrospective observational study. The records of patients who underwent upper abdominal surgery in our hospital from June 2019 to January 2021 were selected and retrospectively divided into two groups based on the analgesia method. Fifty-nine patients received ultrasound-guided SAPB analgesia (SAPB-group) and 55 patients received ultrasound-guided TPVB analgesia (TPVB-Group). Patients were matched for age, gender and body-mass index (BMI). The visual analogue scale (VAS) scores of pain at two hours(T1), six hours (T2), 12 hours (T3), 24 hours (T4) and 48 hours (T5) after the operation were compared between the two groups. The levels of interleukin-6 (IL-6), interleukin-10(IL-10) and tumor necrosis factor-α (TNF-α) at the completion of surgery (T0) and T4 were compared between the two groups. Results: The duration of block in SAPB-group was higher than that in TPVB-group (P<0.05). VAS scores of SAPB-groups were significantly lower than those of TPVB-group at all-time points (P<0.05) except at rest 48 hour after the procedure. The levels of IL-6, IL-10 and TNF-α at 24 hours after the operation in both groups were significantly higher than immediately at the end of the operation (P<0.05). Levels of IL-6 and TNF-α 24 hours after the operation were significantly lower in the SAPB-group than in the TPVB-group (P<0.05), while the levels of IL-10 24 hours after the operation were significantly higher in the SAPB-group (P<0.05). Conclusions: SAPB block under ultrasound guidance for patients undergoing upper abdominal surgery has good anesthetic and analgesic effect and can significantly improve the level of postoperative inflammation. doi: https://doi.org/10.12669/pjms.39.1.6849 How to cite this: Cai Z, Xie R, Xu T, Huang C. Comparison of ultrasound-guided serratus anterior plane block and thoracic paravertebral block in postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6849 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Local anesthetic distribution above pleura was checked by moving the probe up and down to confirm. [9][10][11] After the operation, patients' vital signs, tidal volume, airway pressure, hipoxemia events and other respiratory parameters were observed.…”

Section: Thoracic Paravertebral Blockmentioning

confidence: 99%

Effects of thoracic paravertebral nerve block on postoperative pain and postoperative delirium in elderly patients undergoing thoracoscopic lobectomy

et al. 2023

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Objectives: To evaluate the effects of ultrasound-guided thoracic paravertebral nerve block on perioperative pain and postoperative delirium in elderly patients undergoing thoracoscopic lobotomy. Methods: Patients aged 60 to 80 years who underwent the surgery of thoracoscopic lobectomy were selected; ASA grades I to III and New York Heart Association (NYHA) grades I to II. Patients were randomly divided into two groups: group C (group Compaired) and group T (group Thoracic Paravertebral Nerve Block TPVB). Patients in group T received ultrason-guided TPVB while those in group C didn’t received TPVB. Postoperative patient-controlled intravenous analgesia was administered to all the patients. The consumption of intraoperative opioids, cases of hipoxemia, operative time, and extubation time was also recorded. Pain scores (static and dynamic) were assessed at 2, 4, 6, 24, 48, 72, 96, and 120 hours point after the operation. Pain scores, occurrence of postoperative delirium occurrence, postoperative complications, total amount of analgesic drugs, length of hospital stay, rescue analgesic requirement, and side effects were recorded within 5 days. Results: Intraoperative dosages of sufentanil and remifentanil were significantly lower in group T (Table 1). The postoperative recovery time in group T was significantly shortened (Table 1). The VAS pain scores of group T at 2, 4, 6, and 24 hours after surgery were much lower. The consumption of intraoperative opioids, number of rescue analgesic requirements, and the occurrence of postoperative delirium incidence in group T was significantly reduced (Table 2). There were no differences in hipoxemia events, postoperative nausea, vomiting and pulmonary complications between the two groups (Table 2). Table 1Sufentanil and remifentanil consumption. The total amount of Group C (n = 105) Group T (n = 103) P value Sufentanil (µg/kg) 0.91 ± 0.26 0.68 ± 0.17** <.01 Remifentanil (µg/kg) 18.8 ± 2.9 14.7 ± 1.5** <.01 Table 2Postoperative static VAS pain score. 2 h 4 h 6 h 24 h 48 h 72 h 96 h 120 h Group C (n = 105) 3.6 ± 1.1 3.7 ± 1.0 2.9 ± 0.9 2.6 ± 1.3 1.4 ± 0.8 0.6 ± 0.6 0.1 ± 0.3 0 Group T (n = 103) 2.6 ± 0.9** 2.5 ± 0.8** 2.1 ± 0.7** 1.7 ± 0.7** 1.2 ± 0.8 0.7 ± 0.7 0 ± 0.22 0 P <.01 <.01 <.01 <.01 .129 .571 .128 Conclusion: Preoperative ultrasound-guided thoracic paravertebral nerve block (TPVB) can obviously decrease the intraoperative and postoperative opioids consumption, shorten the recovery time, reduce the number of rescue analgesia and the incidence of postoperative delirium in elderly patients undergoing thoracoscopic lobotomy.

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Efficacy of serratus anterior plane block versus thoracic paravertebral block for postoperative analgesia after breast cancer surgery - a randomized trial

Cited by 15 publications

References 25 publications

The effects of ultrasound-guided serratus anterior plane block on intraoperative opioid consumption and hemodynamic stability during breast surgery: A randomized controlled study

The effects of ultrasound-guided serratus anterior plane block on intraoperative opioid consumption and hemodynamic stability during breast surgery: A randomized controlled study

Comparison of ultrasound-guided serratus anterior plane block and thoracic paravertebral block in postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery

Effects of thoracic paravertebral nerve block on postoperative pain and postoperative delirium in elderly patients undergoing thoracoscopic lobectomy

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