Observation of the analgesic effect of superficial or deep anterior serratus plane block on patients undergoing thoracoscopic lobectomy

Abstract

The effectiveness of anterior serratus plane block in postoperative analgesia of thoracic surgery is beginning to emerge. Currently, there are 2 methods of anterior serratus plane block: deep serratus plane block (DSPB) and superficial serratus plane block (SSPB). In clinical practice, there is no an unified view regarding the advantages and disadvantages between 2 methods. This study aimed to observe and compare the analgesic effects of 2 methods on patients undergoing thoracoscopic lobectomy, in order to provide some suggestions for anesthesiologists when they choose anterior serratus plane block to perform postoperative analgesia for patients. Patients were randomly divided into 3 groups (21 patients/group): The patients in groups S and D received 0.4 ml/kg of 0.375% ropivacaine for ultrasound-guided block after surgery. Postoperatively, flurbiprofen was used for rescue analgesia. Visual analog scale (VAS) pain scores were recorded at 6 hours, 12 hours, and 24 hours after surgery, and rescue analgesia, post-operative nausea, and vomiting were reported within 24 hours after surgery. At 6 hours, 12 hours, and 24 hours, the VAS scores and the rescue analgesia rates in groups S and D were significantly lower than those in group P (all P < .001). With prolonging time, the VAS in group D was significantly increased by 0.11 per hour as compared with that of group P (P < .0001); VAS in group D was significantly increased by 0.12 per hour as compared with that of group S (P < .0001). Ultrasound-guided anterior serratus plane block can provide adequate analgesia for patients undergoing thoracoscopy lobectomy. SSPB can significantly improve VAS scores as compared to DSPB at 24 hours.

Analgesic efficacy of the superficial versus deep serratus plane blocks for mastectomy with axillary clearance: A randomized controlled trial

“…In contrast, because of their origin and trajectory, the long thoracic nerve cannot be blocked by the deep serratus plane block. [16] In this study, the median time to first analgesia rescue was longer in the superficial serratus block group (P < .001), which was similar to that observed in the case series reported by Bhoi et al [19] An earlier study by Blanco's among healthy volunteers found longer duration of paresthesia with the superficial than the deep serratus plane block, where mean duration (SD) of paresthesia was 752 (21) minutes and 386 (160) minutes, respectively. [4] Abdallah however found no difference in time to first analgesic request between the blocks.…”

“…Axillary lymph node dissection or clearance involved extension of the surgical incision to the lateral aspect of the hemithorax, where the superficial serratus plane block would provide adequate analgesic coverage, but not the deep serratus plane block. [ 16 ] Their patients who did not have axillary clearance may not have benefited from the added analgesic coverage provided by the superficial serratus plane block, hence possibly accounting for the comparable results. In our study, all the patients had mastectomy and axillary clearance.…”

“…In contrast, because of their origin and trajectory, the long thoracic nerve cannot be blocked by the deep serratus plane block. [ 16 ]…”

The Combination of Two Regional Anesthesia Techniques in a High-Risk Patient: A Case Report

“…The serratus anterior plane block is a block that has been described in recent years and aims to block the thoracodorsal nerve (anesthesia in thoracic dermatomes, T2-T12) [3] . It is used in breast surgeries, rib fractures, thoracic surgeries, and traumas to provide analgesia in the postoperative period and in the placement of subcutaneous implantable cardioverter-defibrillator (S-ICD) for the intraoperative anesthesia [5][6][7][8] .…”

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.…”