Application of a new serratus anterior plane block in modified radical mastectomy under ultrasound guidance: A prospective, randomized controlled trial

Tang, Weixiang; Luo, Guangtao; Lu, Yao; Chen, Chen; Liu, Hu; Li, Yuanhai

doi:10.1016/j.jclinane.2021.110377

Cited by 12 publications

(11 citation statements)

References 20 publications

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“…After review, a further 1116 studies were excluded as not meeting our predefined criteria. Finally, 62 studies evaluating nine different regional analgesia techniques were used for the quantitative analysis 14–75 . The regional and local analgesia techniques were: erector spinae plane (ESP) block, local anaesthetic infiltration, paravertebral block (PVB), pectoserratus plane (PS) block, superficial serratus anterior plane (sSAP) block, retrolaminar block, deep serratus anterior plane (dSAP) block, rhomboid plane block, interpectoral-pectoserratus (IP-PS) block.…”

Section: Resultsmentioning

confidence: 99%

Single-injection regional analgesia techniques for mastectomy surgery

Cassai

Zarantonello

Geraldini

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Patients undergoing mastectomy surgery experience severe postoperative pain. Several regional techniques have been developed to reduce pain intensity but it is unclear, which of these techniques is most effective.OBJECTIVES To synthesise direct and indirect comparisons for the relative efficacy of different regional and local analgesia techniques in the setting of unilateral mastectomy. Postoperative opioid consumption at 24 h, postoperative pain at extubation, 1, 12 and 24 h, postoperative nausea and vomiting were collected.DESIGN Systematic review with network meta-analysis (PROSPERO: CRD42021250651).DATA SOURCE PubMed, Scopus, the Cochrane Central Register of Controlled Trials (from inception until 7 July 2021).ELIGIBILITY CRITERIA All randomised controlled trials investigating single-injection regional and local analgesia techniques in adult patients undergoing unilateral mastectomy were included in our study without any language or publication date restriction.RESULTS Sixty-two included studies randomising 4074 patients and investigating nine techniques entered the analysis. All techniques were associated with less opioid consumption compared with controls The greatest mean difference [95% confidence interval (CI)] was associated with deep serratus anterior plane block: mean difference -16.1 mg (95% CI, -20.7 to -11.6). The greatest reduction in pain score was associated with the interpectoral-pectoserratus plane block (mean difference -1.3, 95% CI, -1.6 to -1) at 12 h postoperatively, and with superficial serratus anterior plane block (mean difference -1.4, 95% CI, -2.4 to -0.5) at 24 h. Interpectoral-pectoserratus plane block resulted in the greatest statistically significant reduction in postoperative nausea/vomiting when compared with placebo/no intervention with an OR of 0.23 (95% CI, 0.13 to 0.40).CONCLUSION All techniques were associated with superior analgesia and less opioid consumption compared with controls. No single technique was identified as superior to others. In comparison, local anaesthetic infiltration does not offer advantages over multimodal analgesia alone.TRIAL REGISTRATION PROSPERO (CRD4202125065).

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Section: Resultsmentioning

confidence: 99%

Single-injection regional analgesia techniques for mastectomy surgery

Cassai

Zarantonello

Geraldini

et al. 2021

European Journal of Anaesthesiology

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“…Disease Markers excessive application of fentanyl can lead to reactions such as drowsiness, nausea, and vomiting, and even death due to respiratory depression in severe cases [19,20]. Therefore, dosage control of fentanyl is required, which has always been the key and difficult content of TIVA.…”

Section: Discussionmentioning

confidence: 99%

Clinical Value of Total Intravenous Anesthesia with Sufentanil and Propofol in Radical Mastectomy

2022

Disease Markers

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Objective. To investigate the clinical value of sufentanil combined with propofol for total intravenous anesthesia (TIVA) in radical mastectomy. Methods. The data of 120 patients undergoing radical mastectomy of breast cancer in our hospital from February 2020 to February 2021 were retrospectively analyzed, and they were randomly assigned to the experimental group (EXG) ( n = 60 ) and the control group (COG) ( n = 60 ). The anesthesia maintenance scheme was 0.01–0.03 μg/(kg·min) of sufentanil + 80 –100 μg/(kg·min) of propofol in EXG and 3 μg/(kg·h) of fentanyl + 80 –100 μg/(kg·min) of propofol in COG. The hemodynamic indices, stress indexes, postoperative pain scores, and incidence of adverse reactions were compared between EXG and COG. Results. The heart rates (HR) and mean arterial pressure (MAP) after tracheal intubation (T2) and at separation of deep tissues (T3), tracheal extubation (T4), and the end of surgery (T5) were markedly lower in EXG than in COG ( P < 0.001 ). The stress indexes and postoperative pain scores at 1 h (T6), 6 h (T7), and 12 h (T8) after surgery were lower in EXG than in COG ( P < 0.001 ). The incidence of dizziness, headache, pruritus, and emergence agitation in EXG was lower compared with that in COG ( P < 0.05 ). Conclusion. Sufentanil combined with propofol for TIVA can stabilize intraoperative hemodynamic indices of patients undergoing radical mastectomy, alleviate perioperative stress response, and reduce pain perception. Therefore, this anesthesia method is safe and merits clinical promotion.

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“…The risk assessment of the included studies is shown in Figure 2. All included studies in the analysis were clinical RCTs, 10 studies were judged as having a low risk of bias [5,14,15,22,31,33,35,36,46,51], 3 studies were judged as having a high risk of bias [30,34,50], and the remaining 16 studies were judged to have an unclear risk of bias. Additionally, 4 studies did not provide enough information about allocation concealment [16,30,47,49].…”

Section: Assessment Of Methodological Qualitymentioning

confidence: 99%

“…No significant difference was shown 6 h after surgery, probably due to the limited number of included studies. Additionally, 24 studies analyzed postoperative movement or cough pain scores with the use of SAPB in patients undergoing thoracic or breast surgery [4,5,15,16,[30][31][32][33][34][35][36][37][38]. Metaanalysis showed that compared with the control group, the SAPB group showed significantly reduced movement or cough pain scores at different postoperative time points, except for 48 h postoperatively (Figures 5-7…”

Section: Postoperative Pain Scoresmentioning

confidence: 99%

“…Seventeen studies reported intraoperative opioid consumption in patients undergoing thoracic or breast surgery [5,14,15,30,32,33,35,36,38,39,44,49]. Meta-analysis showed that SAPB significantly reduced intraoperative opioid consumption compared with that in the control group (Supplementary Figure 1) (SMD, −0.66; 95% CI, −1.03 to −0.28; P < 0.01; I 2 = 90%).…”

Section: Intraoperative Opioid Consumptionmentioning

confidence: 99%

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Efficacy and safety of ultrasound-guided serratus anterior plane block for postoperative analgesia in thoracic surgery and breast surgery: A systematic review and meta-analysis of randomized controlled studies

Zhang¹,

Wu²,

Liu³

et al. 2022

Front. Anesthesiol.

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ObjectiveSerratus anterior plane block (SAPB) is a new perioperative analgesia for patients undergoing thoracic and breast surgery. The primary purpose of this systematic review and meta-analysis was to investigate whether ultrasound-guided SAPB combined with general anesthesia provides safer and more effective postoperative analgesia than general anesthesia alone or general anesthesia combined with incisional local infiltration anesthesia in patients receiving thoracic and breast surgery.MethodsWe systematically searched PubMed, Embase, Web of Science and the Cochrane Library databases for clinical randomized controlled trials (RCTs) of SAPB for postoperative analgesia in thoracic and breast surgery. The primary outcome was the postoperative pain score. Secondary outcomes included intraoperative opioid consumption, 24-h postoperative opioid consumption, time to first use of analgesics, number of patients requiring urgent additional analgesics, opioid complications (postoperative nausea, vomiting, respiratory depression, constipation, dizziness, sedation) and length of hospital stay. The risk of bias was assessed using the Cochrane method and Jadad score.ResultsA total of 29 RCTs with 1,978 patients were included. Twelve studies included thoracic surgery, and 17 studies included breast surgery. The results of the meta-analysis showed that the rest or movement pain scores of the SAPB group were significantly lower than those of the control group at each postoperative time point. In addition, morphine consumption was significantly reduced in the SAPB group at 24 h postoperatively (standardized mean differences [SMD], −2.77; 95% confidence interval [CI], −3.56 to −1.97; P < 0.01). Intraoperative opioid consumption was significantly reduced in the SAPB group (SMD, −0.66; 95% CI, −1.03 to −0.28; P < 0.01); and the number of patients requiring urgent additional pain medication postoperatively (risk ratio [RR], 0.34; 95% CI,0.27 to 0.42; P < 0.01) was significantly lower; and the time to first use of analgesics was significantly longer (SMD, 3.49; 95% CI, 2.23 to 4.74; P < 0.01); and the incidence of postoperative nausea and vomiting (PONV) (RR, 0.43; 95% CI, 0.34 to 0.54; P < 0.01), constipation (RR, 0.12; 95% CI, 0.03 to 0.52; P < 0.01; I2 = 0), dizziness (RR, 0.24; 95% CI, 0.06 to 0.92; P < 0.05; I2 = 0) and sedation (RR, 0.07; 95% CI, 0.01 to 0.52; P < 0.01; I2 = 0) were significantly lower; the length of hospital stay was significantly shorter (SMD, −0.28; 95% CI, −0.46 to −0.09; P < 0.01) and the SAPB group have a significantly reduced the incidence of postoperative pain syndrome at 3 months.ConclusionsCompared with no SAPB block, ultrasound-guided SAPB provides superior postoperative analgesia by reducing postoperative pain scores, the incidence of postoperative pain syndrome at 3 months and perioperative opioid consumption in patients after thoracic and breast surgery. At the same time, SAPB reduces the incidence of side effects of opioids and shortens the length of hospital stay. SAPB can be used as a feasible technique for multimodal analgesia in the perioperative period.

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Application of a new serratus anterior plane block in modified radical mastectomy under ultrasound guidance: A prospective, randomized controlled trial

Cited by 12 publications

References 20 publications

Single-injection regional analgesia techniques for mastectomy surgery

Single-injection regional analgesia techniques for mastectomy surgery

Clinical Value of Total Intravenous Anesthesia with Sufentanil and Propofol in Radical Mastectomy

Efficacy and safety of ultrasound-guided serratus anterior plane block for postoperative analgesia in thoracic surgery and breast surgery: A systematic review and meta-analysis of randomized controlled studies

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