The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy

Abstract

Background: Thoracotomy is one of the most painful surgeries; therefore, video-assisted thoracoscopic surgery (VATS) was developed to reduce the surgical stress of thoracotomy. Although VATS results in reduced postoperative pain compared with thoracotomy, it is still painful. Serratus plane block (SPB) is a novel technique that provides lateral chest wall analgesia by blocking the lateral branch of the intercostal nerve. Methods: We conducted a prospective study in 50 patients, aged 20 to 75 years, undergoing three-port VATS lobectomy. Group G (n = 25) received conventional general anesthesia and Group S (n = 25) received SPB before induction of general anesthesia. In Group S, 20 ml of 0.375% ropivacaine was injected between the serratus anterior and latissimus dorsi muscles. During surgery, anesthesia was maintained by adjusting the propofol dose to maintain a bispectral index of 40 to 60 and the remifentanil dose to maintain blood pressure and heart rate within 70 to 130% of baseline. Results: Intraoperative remifentanil consumption was significantly lower in Group S compared to that in Group G (519.9 μg vs 1047.7 μg, P < .001). Moreover, emergence time was significantly shorter in Group S compared to Group G (10.8 minutes vs 14.9 minutes, P = .01). However, there were no significant differences in systolic blood pressure and heart rate (HR) between the groups at each time point. The doses of rescue drugs for the control of blood pressure and HR were not significantly different between the 2 groups. Conclusions: Ultrasound-guided SPB could be a safe and effective regional anesthesia technique for VATS

The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: a qualitative systematic review

“…. Fifty‐one studies were identified for inclusion in this review, of which nine were RCTs involving a total of 637 patients (see also Supporting Information, Table S1). Eight RCTs evaluated the serratus anterior plane block in the setting of video‐assisted thoracoscopic surgery (five studies ) and thoracotomy (three studies ).…”

“…Fifty‐one studies were identified for inclusion in this review, of which nine were RCTs involving a total of 637 patients (see also Supporting Information, Table S1). Eight RCTs evaluated the serratus anterior plane block in the setting of video‐assisted thoracoscopic surgery (five studies ) and thoracotomy (three studies ). Five of these compared single‐injection serratus anterior plane block with systemic analgesia alone ; one compared it with thoracic paravertebral blockade and with systemic analgesia alone ; and one compared it with PECS 2 blocks and with intercostal nerve blocks .…”

“…There is level 2 evidence from five RCTs involving 359 patients that single‐injection serratus anterior plane block provides superior postoperative analgesia for up to 24 h after video‐assisted thoracoscopic surgery compared with systemic analgesia alone . Kim et al.…”

“…Lee et al. compared a pre‐operative superficial serratus anterior plane block with no block and found that the intervention group had a 51% decrease in intra‐operative remifentanil requirements, which was also associated with a more rapid emergence. Pain scores and postoperative opioid use were not reported.…”

Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial

“…[17] As an important element of the multimodal analgesia program, regional block is a type of analgesia with high safety and less adverse effects. [18] We chose the subcostal approach to QLB in the study because there are several advantages of this method. (1) It can provide a higher sensory block plane due to higher needle insertion, and we can observe the extent of LA spread in the parasagittal oblique plane.…”