Serratus Anterior Plane Block and Erector Spinae Plane Block Versus Thoracic Epidural Analgesia for Perioperative Thoracotomy Pain Control: A Randomized Controlled Study

Elsabeeny, Walaa Y; Shehab, Nahla N; Mohamed, Abdelrahman; Wadod, Mohamed A.

doi:10.1053/j.jvca.2020.12.047

Cited by 48 publications

(53 citation statements)

References 29 publications

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“…[ 6 ] Also, other researchers have demonstrated that ESPB had superior analgesia to SAPB after thoracotomy and video-assisted thoracoscopy. [ 7 8 ]…”

Section: Discussionmentioning

confidence: 99%

Serratus anterior plane block and erector spinae plane block in postoperative analgesia in thoracotomy: A randomised controlled study

Hassan

Wadod²

2022

Indian J Anaesth

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Background and Aims: Managing pain after thoracic surgery is crucial and the traditional methods have many adverse effects. We aimed to evaluate serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in acute pain control in thoracic cancer surgeries. Methods: This randomised controlled, triple-blind study was performed on 90 patients, between 18 and 70 years old, scheduled for elective thoracic cancer surgery. Patients were allocated into three equal groups: Control group: received sham ESPB and sham SAPB. SAPB group received SAPB (20 ml bupivacaine 0.5%) and sham ESPB. ESBP group received ESPB (20 ml bupivacaine 0.5%) and sham SAPB. Results: Postoperative morphine consumption was significantly lower in ESBP and SAPB groups than control group [ESPB (8.52 ± 4.29 mg) < SAPB (19.57 ± 7.63 mg) < control (36.37 ± 8.27 mg)] ( P < 0.001). Numerical rating scale pain score was comparable among the groups at rest, but was significantly lower at 30 min, 2, 4 h in ESPB and SAPB groups, than control group on coughing. The scores were better in SAPB compared to control group till 4 h. At 8, 12, 24 h, the difference between control and SAPB groups became insignificant, but it remained the least in ESPB group. Postoperative forced vital capacity and forced expiratory volume in the first second after 24 h were the best in ESPB group and better in SAPB group compared to the control group. Conclusion: Both ESPB and SAPB reduced intraoperative and postoperative opioid consumptions and postoperative dynamic pain scores with improved postoperative pulmonary functions in thoracic surgery with the ESPB being superior.

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“…[ 6 ] Also, other researchers have demonstrated that ESPB had superior analgesia to SAPB after thoracotomy and video-assisted thoracoscopy. [ 7 8 ]…”

Section: Discussionmentioning

confidence: 99%

Serratus anterior plane block and erector spinae plane block in postoperative analgesia in thoracotomy: A randomised controlled study

Hassan

Wadod²

2022

Indian J Anaesth

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“…Surgical resection remains the main treatment for operable lung cancer patients [ 2 ]. However, lung cancer surgery can lead to severe postoperative pain [ 3 ]. With the popularization of video-assisted thoracoscopic minimally invasive surgery, the degree of postoperative pain has decreased compared with the degree of postoperative pain after open surgery, which is mainly due to the use of completely non-rib-spreading techniques [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the analgesic effect of ultrasound-guided paravertebral block and ultrasound-guided retrolaminar block in Uniportal video-assisted Thoracoscopic surgery: a prospective, randomized study

Wang

Wei

et al. 2021

BMC Cancer

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Background The optimal modality for postoperative analgesia after uniportal video-assisted thoracoscopic surgery (UVATS) for the treatment of lung cancer has not yet been determined. Both ultrasound-guided paravertebral block (PVB) and retrolaminar block (RLB) have been reported to be successful in providing analgesia after UVATS. However, which block technique provides superior analgesia after UVATS is still unclear. This randomized study was designed to compare the postoperative analgesic effects and adverse events associated with ultrasound-guided PVB and RLB after UVATS. Methods Sixty patients with lung cancer were randomized to undergo ultrasound-guided PVB (group P) or ultrasound-guided RLB (group R). In group P, 30 mL of 0.5% ropivacaine was injected at the T3 and T5 levels via ultrasound-guided PVB (15 mL at each level on the operative side). In group R, 30 mL of 0.5% ropivacaine was injected at the T3 and T5 levels via ultrasound-guided RLB (15 mL at each level on the operative side). The primary outcome was the numerical rating scale (NRS) score within 48 h after surgery. The secondary outcomes were total postoperative sufentanil consumption, time to first analgesic request and adverse events. Results At 3, 6, 12, 24, 36 and 48 h postoperatively, the NRS score at rest in group P was lower than that in group R (p < 0.05). At 3, 6, 12, 24 and 36 h postoperatively, the NRS score while coughing in group P was lower than that in group R (p < 0.05). The total postoperative sufentanil consumption in group P was significantly lower than that in group R (p < 0.001). Additionally, the time to first analgesic request was longer in group R than in group P (p < 0.0001). The incidence of nausea in group R was higher than that in group P (p < 0.05). Conclusions In patients with lung cancer undergoing UVATS, ultrasound-guided PVB with 0.5% ropivacaine provides better analgesia and results in less nausea than ultrasound-guided RLB. Compared with ultrasound-guided RLB, ultrasound-guided PVB seems to be a better technique for analgesia in UVATS. Trial registration The name of this study is the Effect And Mechanism Of Ultrasound-guided Multimodal Regional Nerve Block On Acute And Chronic Pain After Thoracic Surgery. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100044060). The date of registration was March 9, 2021.

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“…Additionally, Elsabeeny et al demonstrated that MAP and the percentage of patients who required intraoperative rescue fentanyl in cancer patients undergoing thoracotomy were significantly higher with SAPB than with TEA intraoperatively. 24 Additionally, postoperative analgesia was better with TEA, which was evident by a lower percentage of patients who required postoperative morphine, prolonged first time to receive morphine, lower total postoperative morphine consumption, and lower postoperative VAS values in the first 24 h at rest.…”

Section: Discussionmentioning

confidence: 91%

Ultrasound–guided serratus anterior plane block versus thoracic epidural analgesia for acute post–thoracotomy pain: a prospective randomized controlled study

Mostafa¹,

Bakeer²,

Gamal³

2021

Anaesth. pain intensive care

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Background: Post–thoracotomy pain can result not only in discomfort to the patient but also in pulmonary complications, due to ineffective coughing, which leads to retention of secretions. It can result into chronic post–thoracotomy pain in the long term. Many analgesic techniques are in use to control it, including continuous serratus anterior plane block (SAPB) and thoracic epidural analgesia (TEA). We compared the efficacy and safety of SAPB with continuous TEA in patients undergoing open lung resection. Methodology: This randomized, open–labeled, parallel–controlled trial was done in 60 patients aged 20 to 60 y with American Society of Anesthesiologists physical status II–III, who underwent elective thoracotomy for lung cancer surgery. Patients were randomly allocated according to analgesia either via a thoracic epidural catheter (10 ml levobupivacaine 0.25%, followed by 5 ml/h of 0.125%) or an ultrasound–guided SAPB (30 ml levobupivacaine 0.25% followed by 5 ml/h of 0.125%). Mean arterial pressure and heart rate were recorded during and after the surgery. Inj. fentanyl was used as rescue analgesia. Postoperatively VAS at rest and on coughing was used to assess the pain. Any complications were noted. Results: After excluding five patients, 27 and 28 patients were allocated to the TEA and SAPB groups, respectively. Intraoperatively and until 24 h after the end of surgery, the mean arterial pressure and heart rate were higher in the SAPB group than in the TEA group. Intraoperatively, the requirement for fentanyl was more in the SAPB group. Postoperatively, VAS at rest and cough were significantly higher in the SAPB group. The occurrence of nausea and vomiting, hypotension, and bradycardia were similar in the groups. Conclusions: In patients undergoing open lung resection for cancer, continuous serratus anterior plane block was less effective than thoracic epidural analgesia in controlling postoperative pain and presented similar adverse events. Key words: Serratus anterior plane block; Thoracic epidural, Continuous; Thoracotomy pain, Acute Abbreviations: PTP – Post–thoracotomy pain; TEA – Thoracic epidural analgesia; VAS – Visual analog scale; SAPB – Serratus anterior plane block; MAP – Mean arterial blood pressure; LA – Local anesthetics Preregistration: The study was registered in the institutional board ethical committee (201617026) and on www.clinicaltrials.gov (NCT03933592) Citation: Mostafa MM, Bakeer AH, Gamal RM. Ultrasound–guided serratus anterior plane block versus thoracic epidural analgesia for acute post–thoracotomy pain: a prospective randomized controlled study. Anaesth. pain intensive care 2021;25(6):733–740 ; DOI: 10.35975/apic.v25i6.1692 Received: July 09, 2021, Reviewed: October 06, 2021, Accepted: October 09, 2021

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Serratus Anterior Plane Block and Erector Spinae Plane Block Versus Thoracic Epidural Analgesia for Perioperative Thoracotomy Pain Control: A Randomized Controlled Study

Cited by 48 publications

References 29 publications

Serratus anterior plane block and erector spinae plane block in postoperative analgesia in thoracotomy: A randomised controlled study

Serratus anterior plane block and erector spinae plane block in postoperative analgesia in thoracotomy: A randomised controlled study

Comparison of the analgesic effect of ultrasound-guided paravertebral block and ultrasound-guided retrolaminar block in Uniportal video-assisted Thoracoscopic surgery: a prospective, randomized study

Ultrasound–guided serratus anterior plane block versus thoracic epidural analgesia for acute post–thoracotomy pain: a prospective randomized controlled study

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