Comparison of the intraoperative analgesic efficacy between ultrasound-guided deep and superficial serratus anterior plane block during video-assisted thoracoscopic lobectomy

Abstract

Background: The serratus anterior plane block (SAPB) is a novel method that provides lateral chest wall analgesia. There are 2 methods of SAPB; deep and superficial SAPB. Each of these methods has been demonstrated to provide effective perioperative analgesia in thoracic surgery. The aim of this study was to compare the intraoperative hemodynamic and analgesic benefits of deep versus superficial SAPB during video-assisted thoracic surgery (VATS) lobectomy. Methods: We performed a prospective, randomized, patient/assessor-blinded trial. We included patients who were 20 to 75 years of age and scheduled to undergo VATS lobectomy with American Society of Anesthesiologists physical status 1 or 2. Patients were randomly allocated to receive either ultrasound-guided deep SAPB (Group D) or superficial SAPB (Group S). The primary outcome was intraoperative remifentanil consumption. We also recorded intraoperative systolic blood pressure (SBP), heart rate (HR), emergence time, and doses of rescue drugs used to manage hemodynamic instability. Results: Data for 50 patients undergoing 3-port VATS lobectomy were analyzed. Intraoperative remifentanil consumption did not differ significantly between Group D (n = 25, 715.62 ± 320.36 μg) and group S (n = 25, 721.08 ± 294.48 μg) (P = .97). Additionally, there were no significant differences between the 2 groups in SBP and HR at any time point, emergence time, or amount of rescue drugs used. Conclusion: Our study suggests that the intraoperative analgesic efficacy is similar for deep and superficial SAPB during VATS lobectomy.

Evaluating the effect of ultrasound–guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial

“…6 It has been reported to provide efficient analgesia in many different trials such as; in patients with multiple rib fracture compared to TEA and PVB [11] , in breast cancer surgeries [12] and minimal invasive heart surgeries .13 Previous trials were conducted to evaluate the effect of SAPB compared to the TEA in thoracic surgeries. 14, 15,16,17 This study aimed to evaluate the effect of SSPB, DSPB and TEA in thoracotomies in patients with lung cancer. Moreover, Ökmen et al in 2018; compared DSPB to continuous TEA during the postoperative period of thoracotomy and reported that both groups were comparable regarding the VAS scores and the amounts of post-operative analgesic consumption.…”

“…15 In consistent with the results of the current study, Moon et al in 2020 compared SSPB with DSPB in thoracoscopic surgeries and reported comparable level of analgesia during the intra-operative period without any significant changes in hemodynamics between both groups. 16 Recently, Qiu et al in 2021 divided 66 patients into three groups: group received general anesthesia only, group received combined general anesthesia and SSPB and group received general anesthesia with DSPB and reported that the post-operative VAS score and the total amount of rescue analgesia was significantly lower in groups received SSPB and DSPB than the group received general anesthesia alone with significant higher VAS scores in DSPB group compared to SSPB group at 24 hours' time point (P < .001), while no significant differences between 6 hours and 12 hours' time points (P = .262 and .178), so SSPB exhibited more stable and longer-lasting analgesic effect than DSPB. 17…”

Efficacy of Intrathoracic Intercostal Nerve Block on Postoperative Acute and Chronic Pains of Patients Undergoing Video-Assisted Thoracoscopic Surgery

“…The video-assisted thoracoscopic surgery (VATS) is a less-invasive treatment for lung cancer, but many patients still suffer moderate and severe postoperative pain from it. 1 , 2 As the most representative region block, thoracic paravertebral block (TPVB) has been confirmed in the clinic; however, its limitations include the dependency on ultrasound and the not-target spaces spread of local anesthetic. 2 , 3 In recent years, the intrathoracic intercostal nerve block (INB) is frequently applied for its safety and accuracy in pain relief, especially when lacking ultrasound or in face of the contraindications of TPVB.…”

Comparison of the Analgesic Efficacy of Ultrasound-Guided Superficial Serratus Anterior Plane Block With Deep Serratus Anterior Plane Block in Patients Undergoing Modified Radical Mastectomy: A Randomized Clinical Trial

“…Though the superficial SAPB has been found to provide analgesia of the anterior hemithorax, the deep SAPB was not widely studied in mastectomy patients with a dearth of prospective trials comparing the two plane blocks. Although studies have compared the deep SAPB with superficial SAPB [4][5][6], only a few studies have compared the above two blocks in breast cancer surgery patients.…”