Serratus Anterior Block for Long-Term Post-Thoracoscopy Pain Management

Abstract

Purpose Neuropathic, chronic pain is a common and severe complication following thoracic surgery, known as post-thoracotomy pain syndrome (PTPS). Here we evaluated the efficacy of an ultrasound-guided serratus anterior plane block (SAPB) on pain control compared to traditional pain management with intravenous opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) six months after thoracic surgery. Patients and Methods In this retrospective observational study, we analyzed data from a questionnaire survey. We interviewed all patients who underwent elective video-assisted thoracoscopy surgery (VATS) at Soroka University Medical Center between December 2016 and January 2018. The responses of ninety-one patients were included. Results Participants reported PTPS in both groups, 43% of patients in the SAPB group and 57% of patients in the standard group, which failed to reach significance. However, we demonstrated that the percentage of pain occurrence trended lower in the SAPB group. There was significantly less burning/stitching or shooting, shocking, pressure-like, and aching pain in SAPB patients compared to the standard protocol group. Patients in the SAPB group had significantly less pain located in the upper and lower posterior thorax anatomical regions compared to the standard protocol group. Moreover, we found a significant difference in occurrence of PTPS depending on the type of thoracic surgery. From both study groups, 69% of patients who underwent lobectomy reported pain, compared with 41.9% of those in the segmental (wedge resection) procedure, and 42.1% of patients in other procedures. Conclusion While the present study did not demonstrate a statistically significant reduction of PTPS after SAPB concerning postoperative pain control, there was a trend of a decrease. We also found significance in the type of pain and location of pain after thoracic surgery between the two groups, as well as a significant difference between pain occurrence in types of thoracic surgeries from both groups.

Prevalence and Predictors of Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis

“…Thereafter, 183 records were carefully reviewed to ensure compliance with the inclusion criteria. Ultimately, 17 studies [10][11][12][20][21][22][23][24][25][26][27][28][29][30][31][32][33], comprising 10,525 patients who underwent VATS, were included in this study (Fig. 1).…”

Modified pericostal suture technique to reduce postoperative pain and provide optimum anatomic restoration after conversion of minimally invasive thoracic surgery to thoracotomy

“…However, even after minimally invasive thoracic operations, some patients suffer from chronic complaints, although they are less frequent and of lower intensity compared to thoracotomy [31]. Several anaesthesiological strategies to post-thoracotomy analgesia have been proposed to reduce the postoperative pain, such as thoracic epidural analgesia, intrathecal analgesia, paravertebral block, serratus anterior plane block, erector spinae block, intercostal nerve block, cryoablation, interpleural block, and interscalene block [32][33][34][35]. However, none of these techniques has offered a major significant relief of postoperative thoracic pain.…”

The effect of different regional analgesia methods on chronic pain after thoracic surgery

“…There are limited data on the effect of these regional techniques on PTPS. Semyonov et al found no statistically significant decrease in PTPS after a SAPB for postoperative pain control compared to the standard group but reported a decrease in the percentage of PTPS incidence when compared to the standard group [ 22 ]. In our study, VAS scores measured 6 months postoperatively in thoracotomy patients were lower in patients who underwent RIB and SAP block than in patients who underwent regional anesthesia.…”