Serratus plane block for video-assisted thoracoscopic surgery major lung resection: a randomized controlled trial

Abstract

OBJECTIVES The aim of this study was to evaluate the impact of 2 different analgesic approaches on pain, postoperative rehabilitation exercises and rescue analgesics of 2 groups of patients undergoing video-assisted thoracoscopic surgery (VATS) major lung resection for cancer. METHODS A total of 94 patients undergoing a VATS major lung resection were randomly allocated to 2 groups: the control group received intravenous and oral (i.e. systemic) analgesics while the intervention group received systemic analgesics plus pre-emptive serratus plane block. Pain perception was recorded until drainage removal or until 2 p.m. of postoperative day (POD) 3. In particular, the primary end point was defined as the peak pain perception on POD 1 (in the time frame between 6 a.m. and 2 p.m.). Secondary end points were the number of forced inspiration manoeuvers during rehabilitative incentive spirometry on POD 1 and 2 and the overall number of rescue analgesics requested by patients. RESULTS Serratus plane block provided a better pain control between 6 a.m. and 2 p.m. of POD 1 (Numeric Rating Scale 1.7 vs 3.5; P < 0.001). Patients in the intervention group performed more forced inspiration manoeuvers at a mean higher volume during incentive spirometry (8.9 vs 7, P < 0.001, and 1010 vs 865 ml, P = 0.02). They required fewer rescue doses of analgesics (0.57 vs 1.1; P = 0.008). CONCLUSIONS Serratus plane block provided a better pain control, entailing a better performance during postoperative rehabilitation exercises in terms of duration and quality of incentive spirometry. It diminished the patient’s need for rescue analgesics during the early postoperative period. Clinical trial registration number NCT03134729.

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

“…It is worth noting that recent studies have reported that SSPB can significantly help patients with pain associated with chest tumor surgery, [ 21 , 22 ] although similar effects of DSPB have also been reported in several previous studies. [ 23 , 24 ] In the present study, we observed that the analgesic effect of SSPB was more stable and lasting-longer than that of DSPB. The serratus anterior muscle (SAM) is innervated solely by the long thoracic nerve (LTN) (C5–C7).…”

A narrative review of ultrasound-guided serratus anterior plane block

“…Therefore, effective postoperative analgesia can reduce the incidence of pulmonary infection (15). Viti et al (16) randomly divided 94 patients undergoing Videoassisted thoracoscopic surgery major lung resection into two groups: the control group, which received intravenous and oral (i.e., systemic) analgesics and the intervention group, which received systemic analgesics plus pre-emptive SAPB. They found that SAPB provided better pain control, entailing a better performance during postoperative rehabilitation exercises in terms of duration and quality of incentive spirometry.…”

Comparison of the effect of different volumes ropivacaine on deep serratus anterior plane block in patients undergoing breast surgery: a prospective randomized double-blinded trial

“…Because the incisions in this type of surgery are usually distributed in one intercostal space, single or multiple injections of SAP block according to the incision may be more appropriate. Therefore, in a single point SAP block, the volume of local anesthetics used for postoperative analgesia may be relatively too large in thoracoscopic surgery of previous studies (17)(18)(19). The increase in blocked dermatomes does not seem to be proportional to the increase in injection volume.…”