Serratus anterior plane block reduces the prevalence of chronic postsurgical pain after modified radical mastectomy: A randomized controlled trial

Huang, Shibo; Liao, Xincheng; Wu, Junbei; Lin, Qin; Lin, Ying

doi:10.1016/j.jclinane.2021.110410

Cited by 17 publications

(23 citation statements)

References 25 publications

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“…Mobilization is more difficult if the patient is receiving strong pain medications that impair circulation or cause nausea [ 5 ]. Therefore, to positively influence the postoperative pain situation, intraoperative application of long-lasting local anesthetics is a good way to reduce pain [ 17 , 18 , 19 ]. Usually, these allow early mobilization without the need to give opioids.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery after Surgery (ERAS) in DIEP-Flap Breast Reconstructions—A Comparison of Two Reconstructive Centers with and without ERAS-Protocol

Linder

Walle

Loucas

et al. 2022

JPM

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Enhanced recovery after surgery (ERAS) is established for autologous breast reconstruction. ERAS leads to a shortened hospital stay and improved outcome after elective surgery. In this retrospective, two-center case–control study, we compared two different treatment regimens for patients undergoing a DIEP-flap breast reconstruction from two centers, one with an established ERAS protocol and one without. All patients with DIEP breast reconstructions over the period of 12 months were included. The primary outcome measure was the length of hospital stay (LOS) in days. A total of 79 patients with 95 DIEP-flaps were analyzed. In group A (ERAS) 42 patients were operated with DIEP flaps, in group B (non-ERAS) 37 patients. LOS was significantly reduced in the ERAS group (4.51 days) compared to the non-ERAS group (6.32; p < 0.001). Multivariate analysis showed that, in group A, LOS is significantly affected by surgery duration. BMI in the ERAS group had no effect on LOS. In group B a higher BMI resulted in a significantly higher LOS. In multivariate analysis, neither age nor type for surgery (primary/secondary/after neoadjuvant therapy, etc.) affected LOS. In both groups, no systemic or flap-related complications were observed. Comparing two reconstructive centers with and without implemented ERAS, ERAS led to a significantly decreased LOS for all patients. ERAS implementation does not result in an increased complication rate or flap loss. Postoperative pain can be well managed with basic analgesia using NSAID when intraoperative blocks are applied. The reduced use of opioids was well tolerated. With implementation of ERAS the recovery experience can be enhanced making autologous breast reconstructions more available and attractive for various patients.

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Section: Discussionmentioning

confidence: 99%

Enhanced Recovery after Surgery (ERAS) in DIEP-Flap Breast Reconstructions—A Comparison of Two Reconstructive Centers with and without ERAS-Protocol

Linder

Walle

Loucas

et al. 2022

JPM

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“…11,12 Indeed, single-injection peripheral nerve blocks lasting less than 1 day have lowered persistent postmastectomy pain at 3 and 12 months. 13,14 Extending the peripheral nerve block 2 days with a continuous paravertebral nerve block further lowered the incidence of chronic pain. 15 Cryoneurolysis is an analgesic technique consisting of the application of exceptionally low temperatures (approximately -70°C using nitrous oxide) to reversibly ablate peripheral nerves, resulting in prolonged pain relief termed "cryoanalgesia."…”

Section: Perioperative Medicinementioning

confidence: 99%

mentioning

confidence: 99%

Preoperative Ultrasound-guided Percutaneous Cryoneurolysis for the Treatment of Pain after Mastectomy: A Randomized, Participant- and Observer-masked, Sham-controlled Study

et al. 2022

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Background. Ultrasound-guided percutaneous cryoneurolysis is an analgesic technique in which a percutaneous probe is used to reversibly ablate a peripheral nerve(s) using exceptionally low temperature, and has yet to be evaluated with randomized, controlled trials. Pain following mastectomy can be difficult to treat, and we hypothesized that the severity of surgically-related pain would be lower on postoperative day 2 with the addition of cryoanalgesia as compared with patients receiving solely standard-of-care treatment. Methods. Preoperatively, participants at 1 enrolling center received a single injection ropivacaine 0.5% paravertebral nerve block at T3 or T4 and a perineural was catheter inserted. Participants subsequently had an active or sham ultrasound-guided percutaneous cryoneurolysis procedure of the ipsilateral T2-T5 intercostal nerves in a randomized, patient- and observer-masked fashion. Participants all received a continuous paravertebral block with ropivacaine 0.2% until the early morning of discharge (usually postoperative day 2). The primary end point was the average pain level measured using a 0-10 numeric rating scale the afternoon of postoperative day 2. Participants were followed for 1 year. Results. On postoperative day 2, participants who had received active cryoneurolysis (n=31) had a median [IQR] pain score of 0 [0, 1.4] versus 3.0 [2.0, 5.0] in patients given sham (n=29): difference (97.5%CI) -2.5 (-3.5, -1.5), P<0.001. There was evidence of superior analgesia through Month 12. During the first 3 weeks, cryoneurolysis lowered cumulative opioid use by 98%, with the active group using 0.3 [0, 2.8] mg of oxycodone compared with 15.0 [4.0, 24.0] mg in the sham group (P<0.001). No oral analgesics were required by any patient between Months 1-12. After 1 year chronic pain had developed in 1 (3%) active compared with 5 (17%) sham participants (P<0.001). Conclusions. Percutaneous cryoneurolysis markedly improved analgesia without systemic side effects or complications following mastectomy.

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“…Severe postoperative pain seriously affects the postoperative recovery of patients and prolongs the length of hospital stay [3]. In addition, acute pain after surgery is at risk for progression to chronic pain, which also affects psychological changes, quality of life, and satisfaction of patients [4,5]. At present, the analgesic effect is usually improved by increasing the use of opioids.…”

Section: Introductionmentioning

confidence: 99%

“…It is a safe procedure under ultrasound-guided, and there is no possibility of neurological complications like epidural hematoma [12]. Due to its technical simplicity and relative safety, SAPB can be used for regional nerve blocks for intraoperative and postoperative lateral chest wall analgesia [5,7]. In 2013, Blanco et al [13] first described analgesia by SAPB after breast cancer surgery, and later, SAPB rapidly gained popularity for different types of operations, such as thoracic surgery [14], breast surgery [15], rib fracture surgery [16], and liver surgery [17].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of ultrasound-guided serratus anterior plane block for postoperative analgesia in thoracic surgery and breast surgery: A systematic review and meta-analysis of randomized controlled studies

Zhang¹,

Wu²,

Liu³

et al. 2022

Front. Anesthesiol.

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ObjectiveSerratus anterior plane block (SAPB) is a new perioperative analgesia for patients undergoing thoracic and breast surgery. The primary purpose of this systematic review and meta-analysis was to investigate whether ultrasound-guided SAPB combined with general anesthesia provides safer and more effective postoperative analgesia than general anesthesia alone or general anesthesia combined with incisional local infiltration anesthesia in patients receiving thoracic and breast surgery.MethodsWe systematically searched PubMed, Embase, Web of Science and the Cochrane Library databases for clinical randomized controlled trials (RCTs) of SAPB for postoperative analgesia in thoracic and breast surgery. The primary outcome was the postoperative pain score. Secondary outcomes included intraoperative opioid consumption, 24-h postoperative opioid consumption, time to first use of analgesics, number of patients requiring urgent additional analgesics, opioid complications (postoperative nausea, vomiting, respiratory depression, constipation, dizziness, sedation) and length of hospital stay. The risk of bias was assessed using the Cochrane method and Jadad score.ResultsA total of 29 RCTs with 1,978 patients were included. Twelve studies included thoracic surgery, and 17 studies included breast surgery. The results of the meta-analysis showed that the rest or movement pain scores of the SAPB group were significantly lower than those of the control group at each postoperative time point. In addition, morphine consumption was significantly reduced in the SAPB group at 24 h postoperatively (standardized mean differences [SMD], −2.77; 95% confidence interval [CI], −3.56 to −1.97; P < 0.01). Intraoperative opioid consumption was significantly reduced in the SAPB group (SMD, −0.66; 95% CI, −1.03 to −0.28; P < 0.01); and the number of patients requiring urgent additional pain medication postoperatively (risk ratio [RR], 0.34; 95% CI,0.27 to 0.42; P < 0.01) was significantly lower; and the time to first use of analgesics was significantly longer (SMD, 3.49; 95% CI, 2.23 to 4.74; P < 0.01); and the incidence of postoperative nausea and vomiting (PONV) (RR, 0.43; 95% CI, 0.34 to 0.54; P < 0.01), constipation (RR, 0.12; 95% CI, 0.03 to 0.52; P < 0.01; I2 = 0), dizziness (RR, 0.24; 95% CI, 0.06 to 0.92; P < 0.05; I2 = 0) and sedation (RR, 0.07; 95% CI, 0.01 to 0.52; P < 0.01; I2 = 0) were significantly lower; the length of hospital stay was significantly shorter (SMD, −0.28; 95% CI, −0.46 to −0.09; P < 0.01) and the SAPB group have a significantly reduced the incidence of postoperative pain syndrome at 3 months.ConclusionsCompared with no SAPB block, ultrasound-guided SAPB provides superior postoperative analgesia by reducing postoperative pain scores, the incidence of postoperative pain syndrome at 3 months and perioperative opioid consumption in patients after thoracic and breast surgery. At the same time, SAPB reduces the incidence of side effects of opioids and shortens the length of hospital stay. SAPB can be used as a feasible technique for multimodal analgesia in the perioperative period.

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Serratus anterior plane block reduces the prevalence of chronic postsurgical pain after modified radical mastectomy: A randomized controlled trial

Cited by 17 publications

References 25 publications

Enhanced Recovery after Surgery (ERAS) in DIEP-Flap Breast Reconstructions—A Comparison of Two Reconstructive Centers with and without ERAS-Protocol

Enhanced Recovery after Surgery (ERAS) in DIEP-Flap Breast Reconstructions—A Comparison of Two Reconstructive Centers with and without ERAS-Protocol

Preoperative Ultrasound-guided Percutaneous Cryoneurolysis for the Treatment of Pain after Mastectomy: A Randomized, Participant- and Observer-masked, Sham-controlled Study

Efficacy and safety of ultrasound-guided serratus anterior plane block for postoperative analgesia in thoracic surgery and breast surgery: A systematic review and meta-analysis of randomized controlled studies

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