Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block

Herrero, María; Álvarez, S. López; Fuentes, A. Fadrique; Lorefice, F. Manzano; Bartolomé, Carlos; Zárate, J. González de

doi:10.1016/j.redare.2016.07.002

Cited by 11 publications

(12 citation statements)

References 20 publications

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“…In 2015, Pérez et al [ 23 ] proposed the deep serratus plane block, whereby the ultrasound probe was placed under the outer third of the clavicle while the patient was in the supine position. The probe was then slowly moved to the fifth rib in the mid-axillary line.…”

Section: Ultrasound-guided Blockmentioning

confidence: 99%

The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery

et al. 2021

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Although thoracoscopy has characteristics such as a small surgical incision and low stress response, post-surgical pain after a thoracoscopic operation is no less than that after a thoracotomy. Moreover, poor post-surgical pain management is likely to cause an increased incidence of postoperative pulmonary complications (PPCs) and chronic post-surgical pain. The serratus anterior plane block (SAPB) is a regional anesthesia method whereby local anesthetics (LAs) are injected into the serratus anterior space to block the lateral cutaneous branch of the intercostal nerve, long thoracic nerve, and dorsal thoracic nerve. The block range of the SAPB covers the incisions of videoassisted thoracoscopic surgery (VATS) and the site of the chest tube, which are often located in the antero-lateral chest wall. Therefore, the SAPB can achieve effective analgesia in VATS. For example, 0.125% to 0.25% levobupivacaine (20-25 ml) is widely used for thoracic surgery, which can achieve effective analgesia and avoid adverse reactions. Moreover, it has advantages compared with thoracic segmental epidural block (TEA) and thoracic paravertebral block (TPVB), such as simple operation, increased safety, fewer complications, and hemodynamic stability. In addition, adequate analgesia is helpful for pulmonary function recovery and reduces the incidence of PPCs. This article introduces the anatomical mechanism of the SAPB, diverse operation approaches, how to choose drugs and adjuvants, and the resulting impacted area range. It summarizes the advantages and disadvantages of the SAPB compared with other analgesic methods and posits that the SAPB is beneficial to the recovery of postoperative lung function, which provides more options for postoperative analgesia after VATS.

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Section: Ultrasound-guided Blockmentioning

confidence: 99%

The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery

et al. 2021

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“…Preventive analgesia can inhibit the transmission of noxious stimuli to the central nervous system and reduce the possibility of central or peripheral sensitization to a certain extent. If acute postoperative pain is not well controlled, this pain can easily lead to peripheral sensitization, which, in turn, will lead to abnormal spinal cord regulation, resulting in central sensitization, hyperalgesia, and further chronic pain [ 24 ]. The results of this study showed that the incidence of PMPS in the anterior serratus muscle block group decreased after surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Pain in 70 Women with Breast Cancer Following General Anesthesia for Mastectomy with and without Serratus Anterior Plane Nerve Block

Chai

Yu²,

Qian

et al. 2021

Med Sci Monit

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Background This study was conducted at a single center and aimed to compare postoperative pain in 70 women with breast cancer following general anesthesia for mastectomy with and without serratus anterior plane (SAP) block. Material/Methods A total of 70 breast cancer patients who met the criteria were randomly divided into the general anesthesia combined with SAP block group (group S) and the general anesthesia only group (group G). Perioperative anesthetic drug dosage, the visual analog scale (VAS) score at different time points, and the patient’s satisfaction with analgesia 24 h after surgery, and incidence of postmastectomy pain syndrome (PMPS) were statistically analyzed in the 2 groups. Results Compared with group G, group S had lower intraoperative remifentanil dosages ( P =0.003), a lower total amount of sufentanil via analgesia pump during the 24-h postoperative period ( P <0.001), and lower VAS scores at 2 h, 4 h, and 8 h after surgery, and the differences were significant ( P <0.05). Compared with group G, group S had a shorter first flatus time, got out of bed sooner, had a lower incidence of nausea and vomiting ( P <0.05), and lower incidence of PMPS at 3 and 6 months after the operation ( P <0.05). Conclusions At a single center, preoperative SAP block can significantly reduce postoperative pain after modified radical mastectomy for breast cancer.

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“…We found no differences in PONV or opioid-related postoperative complications; apart from intravenous anesthesia, this was probably due to the lack of statistical power in our sample. The questionnaire we chose to assess postoperative recovery was perhaps outdated; a better choice could have been a performance quality rating scale to better assess the multidimensionality of pain experience 30. Hydrodissection during block was not standardized, and the sensory block was not evaluated, due to the chosen blinding method.…”

Section: Discussionmentioning

confidence: 99%

Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial

Mazzinari

Rovira

Casasempere

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesIn the context of opioid-sparing perioperative management, there is still little evidence from randomized controlled trials regarding the effectiveness of interfascial thoracic blocks. This study hypothesizes that receiving a serratus plane block reduces opioid requirements, pain scores, and rescue medication needs.MethodsThis double-blind, randomized controlled study was conducted on 60 adult females undergoing oncologic breast surgery. After general anesthesia, patients were randomly allocated to either conventional analgesia (control group, n=30) or single-injection serratus block with L-bupivacaine 0.25% 30mL (study group, n=30). First 24-hour total morphine consumption (primary outcome), pain scores at 1, 3, 6, 12, and 24 hours, time-to-first opioid rescue analgesia, and adverse effects were recorded.ResultsMedian 24 hours’ opioid dose was greater in the control group (median difference 9 mg (95% CI 4 to 14.5 mg); p<0.001). Proportional odds model showed that the study group has a lower probability of receiving opioid drugs (OR=0.26 (95% CI 0.10 to 0.68); p<0.001), while mastectomies have a higher probability of receiving them (OR=4.11 (95% CI 1.25 to 13.58); p=0.002). Pain scores in the study group were significantly lower throughout the follow-up period (p<0.001). Control group subjects needed earlier morphine rescue and had a higher risk of rescue dose requirement (p=0.002).ConclusionsInterfascial serratus plane block reduces opioid requirements and is associated with better pain scores and lower and later rescue analgesia needs in the first 24 hours, compared with conventional intravenous analgesia, in breast surgery.Trial registration numberNCT02905149.

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Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block

Cited by 11 publications

References 20 publications

The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery

The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery

Comparison of Postoperative Pain in 70 Women with Breast Cancer Following General Anesthesia for Mastectomy with and without Serratus Anterior Plane Nerve Block

Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial

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